韩国不同气道阻塞严重程度的 COPD 相关医疗保健利用模式和决定因素。
Patterns and determinants of COPD-related healthcare utilization by severity of airway obstruction in Korea.
机构信息
Division of Pulmonology, Department of Internal Medicine, The Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
出版信息
BMC Pulm Med. 2014 Feb 27;14:27. doi: 10.1186/1471-2466-14-27.
BACKGROUND
We investigated patients with chronic obstructive pulmonary disease (COPD) to analyze patterns and identify determinants of healthcare use, according to the severity of airflow obstruction. We used retrospective cohort data from a combination of the 4th Korea National Health and Nutritional Examination Survey (KNHANES) and Korean National Health Insurance (NHI) claims.
METHODS
Demographic and medical claims data were retrospectively analyzed from the 4th KNHANES along with NHI claims. Eligible patients were aged ≥40 years, who underwent complete pulmonary function tests (PFTs), and had at least one inpatient or outpatient claim coded as COPD between January 1, 2007 and December 31, 2010.
RESULTS
Among 6,663 eligible participants, 897 (13.5%) had airway obstruction. Self-reported physician-diagnosed COPD comprised only 3%, and there were 870 undiagnosed COPD patients (97%). Self-reported physician-diagnosed asthma made up 3.7%. Of the 897 respondents, 244 (27.2%) used COPD-related healthcare services. The frequency of healthcare visits increased with increasing severity of airway obstruction. After a 3-year follow-up period, 646 (74.2% of those initially undiagnosed) remained undiagnosed and only 224 (25.8%) were diagnosed and treated for COPD. Only 27.5% of the 244 participants with airway obstruction who used COPD-related healthcare underwent PFTs during the study period. The percentage of prescribed medications associated with COPD increased in accordance with the severity of the COPD. Inhaled long-acting anticholinergics were prescribed for 10.9% of patients with moderate airway obstruction and for 52.4% of patients with severe obstruction. Inhaled long-acting β-agonists combined with corticosteroids were prescribed for 50% of patients with severe airway obstruction. Conversely, 44.6% of healthcare users were prescribed oral theophylline for COPD treatment, and 21.7% were also prescribed an oral corticosteroid. The determinants of COPD-associated healthcare use in respondents with obstructive lung disease were advanced age, severe airflow limitation, presence of comorbidities, and self-reported physician diagnosis of COPD.
CONCLUSIONS
This study ascertained marked underdiagnosed COPD. Although the percentage of prescribed medication used to treat COPD increased with the severity of the COPD, medications primarily prescribed such as oral theophylline or oral corticosteroids are inappropriate for first-line COPD treatment.
背景
我们调查了慢性阻塞性肺疾病（COPD）患者，以根据气流阻塞的严重程度分析医疗保健的使用模式并确定其决定因素。我们使用了第 4 次韩国国家健康和营养检查调查（KNHANES）和韩国国家健康保险（NHI）索赔的组合中的回顾性队列数据。
方法
从第 4 次 KNHANES 以及 NHI 索赔中回顾性地分析了人口统计学和医疗索赔数据。合格的患者年龄≥40 岁，接受了完整的肺功能检查（PFT），并且在 2007 年 1 月 1 日至 2010 年 12 月 31 日之间至少有一次住院或门诊的 COPD 编码。
结果
在 6663 名合格的参与者中，有 897 名（13.5％）有气道阻塞。自我报告的医生诊断的 COPD 仅占 3％，有 870 名未诊断的 COPD 患者（97％）。自我报告的哮喘占 3.7％。在 897 名应答者中，有 244 名（27.2％）使用了与 COPD 相关的医疗服务。随着气道阻塞严重程度的增加，医疗保健的就诊频率也增加。在 3 年的随访期间，646 名（最初未确诊的 74.2％）仍未被诊断出，仅有 224 名（25.8％）被诊断为 COPD 并接受治疗。在患有气道阻塞的 244 名使用 COPD 相关医疗保健的参与者中，只有 27.5％在研究期间接受了 PFT 检查。与 COPD 严重程度相符，与 COPD 相关的药物处方百分比增加。对于中度气道阻塞的患者，有 10.9％的患者被处方了长效抗胆碱能药物，对于严重气道阻塞的患者有 52.4％的患者被处方了长效β-激动剂联合皮质类固醇。对于严重气道阻塞的患者，有 50％的患者被处方了长效β-激动剂联合皮质类固醇。相反，44.6％的医疗保健使用者因 COPD 治疗而被处方了口服茶碱，而 21.7％的患者也被处方了口服皮质类固醇。患有阻塞性肺部疾病的应答者中 COPD 相关医疗保健使用的决定因素是年龄较大，严重气流受限，合并症以及自我报告的 COPD 医生诊断。
结论
本研究确定了明显的未被诊断的 COPD。尽管用于治疗 COPD 的药物处方百分比随着 COPD 的严重程度而增加，但主要处方的药物，例如口服茶碱或口服皮质类固醇，并不适合作为 COPD 的一线治疗。
Zotero 插件