Differences in care between general medicine and respiratory specialists in the management of patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease

Wijayaratne, Kurugamage; Wilson, Jessica; Sivakumaran, Pathmanathan; Sriram, Krishna

doi:10.4103/1817-1737.118499

Cited by 20 publications

(21 citation statements)

References 25 publications

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“…Previous studies have compared the differences in GP and respiratory specialist in terms of post-exacerbation management and outcomes, with one showing that although there were no differences in the 12-month re-admission and mortality rates between patients, there was significant difference in the management of acute exacerbations between the two groups. 22 One potential mechanism explaining the seemingly higher adherence to guidelines among GPs in our study is that generally more complicated patients, such as those with more intensive symptoms, unsatisfactory response to previous therapies, and higher burden of comorbidity, are referred to specialists. This might result in specialists having to consider several different factors in their choice of treatment, not just what guidelines recommend.…”

Section: Discussionmentioning

confidence: 74%

Are COPD Prescription Patterns Aligned with Guidelines? Evidence from a Canadian Population-Based Study

Bahremand¹,

Etminan²,

Roshan-Moniri³

et al. 2021

COPD

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Background In contemporary guidelines for the management of Chronic Obstructive Pulmonary Disease (COPD), the history of acute exacerbations plays an important role in the choice of long-term inhaled therapies. This study aimed at evaluating population-level trends of filled inhaled prescriptions over the time course of COPD and their relation to the history of exacerbations. Methods We used administrative health databases in British Columbia, Canada (1997–2015), to create a retrospective incident cohort of individuals with diagnosed COPD. We quantified long-acting inhaled medication prescriptions within each year of follow-up and documented their trend over the time course of COPD. Using generalized linear models, we investigated the association between the frequent exacerbator status (≥2 moderate or ≥1 severe exacerbation(s) in the previous 12 months) and filling a prescription after a physician visit. Results 132,004 COPD patients were included (mean age 68.6, 49.2% female). The most common medication class during the first year of diagnosis was inhaled corticosteroids (ICS, used by 49.9%), followed by long-acting beta-2 adrenoreceptor agonists (LABA, 31.8%). Long-acting muscarinic receptor antagonists (LAMA) were the least commonly prescribed (10.4%). ICS remained the most common prescription throughout follow-up, being used by approximately 50% of patients during each year. 39.0% of patients received combination inhaled therapies in their first year of diagnosis, with ICS+LABA being the most common (30.7%). The association with exacerbation history was the most pronounced for triple therapy with an odds ratio (OR) of 2.68 for general practitioners and 2.02 for specialists (p<0.001 for both). Such associations were generally stronger among GPs compared with specialists, with the exception of monotherapy with LABA or ICS. Conclusion We documented low utilization of monotherapies (specifically LAMA) and high utilization of combination therapies (particularly ICS containing). Specialists were less likely to consider exacerbation history in the choice of inhaled therapies compared with GPs.

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Section: Discussionmentioning

confidence: 74%

Are COPD Prescription Patterns Aligned with Guidelines? Evidence from a Canadian Population-Based Study

Bahremand¹,

Etminan²,

Roshan-Moniri³

et al. 2021

COPD

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“…Various factors have been implicated in increasing LOS of hospital admissions, both clinical [ 6 – 10 ] and social [ 11 ]. European health systems have a large inter-hospital variability in terms of resources and the range of services offered [ 12 , 13 ], and some previous reports have found a relationship between LOS and such factors [ 4 , 14 , 15 ], whilst others have not [ 16 , 17 ]. To our knowledge, there has been no comprehensive analysis studying the effects of clinical, organisational and resource factors on LOS in European patients admitted with exacerbations of COPD across a range of European countries and healthcare systems.…”

Section: Introductionmentioning

confidence: 99%

Understanding variation in length of hospital stay for COPD exacerbation: European COPD audit

et al. 2016

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Chronic obstructive pulmonary disease (COPD) care across Europe has high heterogeneity with respect to cost and the services available. Variations in length of stay (LOS) may be attributed to patient characteristics, resource and organisational characteristics, and/or the so-called hospital cluster effect.The European COPD Audit in 13 countries included data from 16 018 hospitalised patients. The recorded variables included information on patient and disease characteristics, and resources available. Variables associated with LOS were evaluated by a multivariate, multilevel analysis.Mean±sd LOS was 8.7±8.3 days (median 7 days, interquartile range 4–11 days). Crude variability between countries was reduced after accounting for clinical factors and the clustering effect. The main factors associated with LOS being longer than the median were related to disease or exacerbation severity, including GOLD class IV (OR 1.77) and use of mechanical ventilation (OR 2.15). Few individual resource variables were associated with LOS after accounting for the hospital cluster effect.This study emphasises the importance of the patients' clinical severity at presentation in predicting LOS. Identifying patients at risk of a long hospital stay at admission and providing targeted interventions offers the potential to reduce LOS for these individuals. The complex interactions between factors and systems were more important that any single resource or organisational factor in determining differences in LOS between hospitals or countries.

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“…On the other hand, AECOPD management by pneumologists follows guidelines closer than that by internists, and this may lead to better management of hospitalized patients and to shorter mean stays. [ 24 25 ]…”

Section: Discussionmentioning

confidence: 99%

Prolonged stay predictors in patients admitted with chronic obstructive pulmonary disease acute exacerbation

et al. 2018

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Objectives:The study aimed to identify the factors related to prolonged stay in those patients admitted with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) to our hospital.Methods:We conducted a retrospective study by reviewing the medical records of all patients admitted with AECOPD to the University Hospital Complex of Santiago de Compostela in 2007 and 2008. To identify variables independently associated with length of stay, we conducted a logistic regression including those variables which proved to be significant in the univariate analysis.Results:Six hundred and sixty-one patients were assessed; 76.6% were male and the mean age was 74.5 years (standard deviation [SD]: 11.48). The mean stay was 11.9 days (SD: 8) and 24% of all patients required prolonged stay. Factors associated with prolonged mean stay in multivariate analysis were admission to the Intensive Care Unit (odds ratio [OR], 14.7), hospitalization by internal medicine (OR, 2.1), and use of noninvasive mechanical ventilation (OR, 1.75).Conclusions:Prolonged stay in AECOPD is primarily related to the unit patients are admitted to, and to the need for more intensive care.

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Differences in care between general medicine and respiratory specialists in the management of patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease

Cited by 20 publications

References 25 publications

Are COPD Prescription Patterns Aligned with Guidelines? Evidence from a Canadian Population-Based Study

Are COPD Prescription Patterns Aligned with Guidelines? Evidence from a Canadian Population-Based Study

Understanding variation in length of hospital stay for COPD exacerbation: European COPD audit

Prolonged stay predictors in patients admitted with chronic obstructive pulmonary disease acute exacerbation

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