Pothirat Chaicharn, Liwsrisakun Chalerm, Bumroongkit Chaiwat, Deesomchok Athavudh, Theerakittikul Theerakorn, Limsukon Atikun
Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Int J Chron Obstruct Pulmon Dis. 2015 Apr 13;10:759-66. doi: 10.2147/COPD.S81267. eCollection 2015.
Care for many chronic health conditions is delivered by both specialists and generalists. Differences in patients' quality of care and management between generalists and specialists have been well documented for asthma, whereas a few studies for COPD reported no differences.
The objective of this study is to compare consistency with Global initiative for chronic Obstructive Lung Disease guidelines, as well as rate, health care utilization, and hospital outcomes of severe acute exacerbation (AE) of COPD patients managed by pulmonologists and internists.
This is a 12-month prospective, comparative observational study among 208 COPD patients who were regularly managed by pulmonologists (Group A) and internists (Group B). Clinical data, health care utilization, and hospital outcomes of the two groups were statistically compared.
Out of 208 enrolled patients, 137 (Group A) and 71 (Group B) were managed by pulmonologists and internists, respectively. Pharmacological treatment corresponding to disease severity stages between the two groups was not statistically different. Group A received care consistent with guidelines in terms of annual influenza vaccination (31.4% vs 9.9%, P<0.001) and pulmonary rehabilitation (24.1% vs 0%, P<0.001) greater than Group B. Group A had reduced rates (12.4% vs 23.9%, P=0.033) and numbers of severe AE (0.20±0.63 person-years vs 0.41±0.80 person-years, P=0.029). Among patients with severe AE requiring mechanical ventilation, Group A had reduced mechanical ventilator duration (1.5 [1-7] days vs 5 [3-29] days, P=0.005), hospital length of stay (3.5 [1-20] days vs 16 [6-29] days, P=0.012), and total hospital cost ($863 [247-2,496] vs $2,095 [763-6,792], P=0.049) as compared with Group B.
This study demonstrated that pulmonologists followed national COPD guidelines more closely than internists. The rates and frequencies of severe AE were significantly lower in patients managed by pulmonologists, and length of hospital stay and cost were significantly lower among the patients with severe AE who required mechanical ventilation.
许多慢性健康状况的护理由专科医生和全科医生共同提供。对于哮喘，全科医生和专科医生在患者护理质量和管理方面的差异已有充分记录，而针对慢性阻塞性肺疾病（COPD）的少数研究报告称并无差异。
本研究的目的是比较呼吸内科医生和内科医生管理的COPD患者在遵循慢性阻塞性肺疾病全球倡议指南方面的一致性，以及严重急性加重（AE）的发生率、医疗保健利用率和住院结局。
这是一项为期12个月的前瞻性、比较性观察研究，对象为208例由呼吸内科医生（A组）和内科医生（B组）定期管理的COPD患者。对两组的临床数据、医疗保健利用率和住院结局进行统计学比较。
在208例登记患者中，分别有137例（A组）和71例（B组）由呼吸内科医生和内科医生管理。两组之间对应疾病严重程度阶段的药物治疗在统计学上无差异。A组在年度流感疫苗接种（31.4%对9.9%，P<0.001）和肺康复（24.1%对0%，P<0.001）方面比B组更符合指南。A组的严重AE发生率（12.4%对23.9%，P=0.033）和严重AE病例数（0.20±0.63人年对0.41±0.80人年，P=0.029）更低。在需要机械通气的严重AE患者中，与B组相比，A组的机械通气持续时间（1.5[1-7]天对5[3-29]天，P=0.005）、住院时间（3.5[1-20]天对16[6-29]天，P=0.012）和总住院费用（863美元[247-2496美元]对2095美元[763-6792美元]，P=0.049）更低。
本研究表明，呼吸内科医生比内科医生更严格地遵循国家COPD指南。由呼吸内科医生管理的患者严重AE的发生率和频率显著更低，在需要机械通气的严重AE患者中，住院时间和费用显著更低。
