Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto Ontario, Canada.
Am J Respir Crit Care Med. 2013 Mar 15;187(6):596-601. doi: 10.1164/rccm.201211-2044OC. Epub 2013 Jan 17.
Chronic obstructive pulmonary disease (COPD), a common manageable condition, is a leading cause of death. A better understanding of its impact on health-care systems would inform strategies to reduce its burden.
To quantify health services use in a large, North American COPD population.
We conducted a cohort study using health administrative data from Ontario, a province with a population of 13 million and universal health-care insurance. All individuals with physician-diagnosed COPD in 2008 were identified and followed for 3 years. Proportions of all hospital visits, emergency department visits, ambulatory care visits, long-term care residence places, and homecare made or used by people with COPD were determined and rates of each compared between people with and without COPD.
A total of 853,438 individuals with COPD (11.8% of the population aged 35 yr and older) were responsible for 24% of hospitalizations, 24% of emergency department visits, and 21% of ambulatory care visits; filled 35% of long-term care places; and used 30% of homecare services. After adjusting for several factors, people with COPD had rates of hospital, emergency department, and ambulatory care visits that were, respectively, 63%, 85%, and 48% higher than the rest of the population. Their rates of long-term care and homecare use were 56 and 59% higher, respectively.
Individuals with COPD use large and disproportionate amounts of health services. Strategies that target this group are needed to improve their health and minimize their need for health services.
慢性阻塞性肺疾病（COPD）是一种常见的可管理疾病，是主要的死亡原因之一。更好地了解其对医疗保健系统的影响将有助于制定减轻其负担的策略。
定量分析大型北美 COPD 人群的卫生服务利用情况。
我们使用安大略省的卫生行政数据进行了一项队列研究，该省拥有 1300 万人口和全民医疗保险。2008 年所有经医生诊断患有 COPD 的患者均被识别并随访 3 年。确定 COPD 患者的所有住院、急诊、门诊、长期护理院和家庭护理就诊或使用比例，并比较 COPD 患者和非 COPD 患者之间的每种就诊的发生率。
共 853438 例 COPD 患者（占 35 岁及以上人群的 11.8%），占住院的 24%、急诊的 24%和门诊的 21%；占长期护理院的 35%；使用家庭护理服务的占 30%。在调整了多个因素后，COPD 患者的住院、急诊和门诊就诊率分别比普通人群高 63%、85%和 48%。他们的长期护理和家庭护理使用率分别高 56%和 59%。
COPD 患者使用大量和不成比例的卫生服务。需要针对该人群制定策略，以改善其健康状况并最大限度地减少其对卫生服务的需求。
