Hunter L C, Lee R J, Butcher I, Weir C J, Fischbacher C M, McAllister D, Wild S H, Hewitt N, Hardie R M
Department of Public Health and Health Policy, NHS Lothian, Edinburgh, Midlothian, UK.
Centre for Population Health Sciences, Medical School, University of Edinburgh, Edinburgh, Midlothian, UK.
BMJ Open. 2016 Jan 22;6(1):e009121. doi: 10.1136/bmjopen-2015-009121.
To investigate patient characteristics of an unselected primary care population associated with risk of first hospital admission and readmission for acute exacerbation of chronic obstructive pulmonary disease (AECOPD).
Retrospective open cohort using pseudonymised electronic primary care data linked to secondary care data.
Primary care; Lothian (population approximately 800,000), Scotland.
Data from 7002 patients from 72 general practices with a COPD diagnosis date between 2000 and 2008 recorded in their primary care record. Patients were followed up until 2010, death or they left a participating practice.
First and subsequent admissions for AECOPD (International Classification of Diseases (ICD) 10 codes J44.0, J44.1 in any diagnostic position) after COPD diagnosis in primary care.
1756 (25%) patients had at least 1 AECOPD admission; 794 (11%) had at least 1 readmission and the risk of readmission increased with each admission. Older age at diagnosis, more severe COPD, low body mass index (BMI), current smoking, increasing deprivation, COPD admissions and interventions for COPD prior to diagnosis in primary care, and comorbidities were associated with higher risk of first AECOPD admission in an adjusted Cox proportional hazards regression model. More severe COPD and COPD admission prior to primary care diagnosis were associated with increased risk of AECOPD readmission in an adjusted Prentice-Williams-Peterson model. High BMI was associated with a lower risk of first AECOPD admission and readmission.
Several patient characteristics were associated with first AECOPD admission in a primary care cohort of people with COPD but fewer were associated with readmission. Prompt diagnosis in primary care may reduce the risk of AECOPD admission and readmission. The study highlights the important role of primary care in preventing or delaying a first AECOPD admission.
调查未经过筛选的基层医疗人群中与慢性阻塞性肺疾病急性加重（AECOPD）首次住院及再入院风险相关的患者特征。
采用与二级医疗数据相链接的匿名电子基层医疗数据进行回顾性开放队列研究。
苏格兰洛锡安地区的基层医疗（人口约80万）。
来自72家全科诊所的7002例患者的数据，其初级保健记录中记录的慢性阻塞性肺疾病诊断日期在2000年至2008年之间。对患者进行随访直至2010年、死亡或离开参与研究的诊所。
基层医疗中慢性阻塞性肺疾病诊断后因AECOPD的首次及后续住院情况（国际疾病分类（ICD）10编码J44.0、J44.1出现在任何诊断位置）。
1756例（25%）患者至少有1次AECOPD住院；794例（11%）患者至少有1次再入院，且再入院风险随每次住院而增加。在调整后的Cox比例风险回归模型中，诊断时年龄较大、慢性阻塞性肺疾病更严重、体重指数（BMI）较低、当前吸烟、贫困程度增加、慢性阻塞性肺疾病住院以及基层医疗诊断前针对慢性阻塞性肺疾病的干预措施和合并症与首次AECOPD住院的较高风险相关。在调整后的普伦蒂斯 - 威廉姆斯 - 彼得森模型中，慢性阻塞性肺疾病更严重以及基层医疗诊断前的慢性阻塞性肺疾病住院与AECOPD再入院风险增加相关。高BMI与首次AECOPD住院及再入院的较低风险相关。
在慢性阻塞性肺疾病基层医疗队列中，有几个患者特征与首次AECOPD住院相关，但与再入院相关的特征较少。基层医疗中的及时诊断可能降低AECOPD住院及再入院风险。该研究强调了基层医疗在预防或延迟首次AECOPD住院方面的重要作用。
