Department of Medicine, University of Toronto, Toronto, ON, Canada.
ICES, Toronto, ON, Canada.
Chest. 2019 Apr;155(4):771-777. doi: 10.1016/j.chest.2018.12.018. Epub 2019 Jan 18.
There is limited knowledge on what proportions of patients with COPD receive ambulatory care from primary care physicians, pulmonologists, or other specialists. We evaluated the types and combinations of physicians who provide ambulatory care to patients with COPD.
We conducted a population-based cross-sectional study using health administrative datasets from Ontario, Canada between April 1, 2014 and March 31, 2015. Individuals age 35 years and older with physician-diagnosed COPD were identified, using a previously validated COPD case definition. The primary outcomes were ambulatory visits to primary care physicians, pulmonologists, and all other specialists within a 1-year period.
There were 895,155 individuals identified as having physician-diagnosed COPD. Of those, 56,533 individuals (6.3%) had no ambulatory care visits, 802,327 (89.6%) saw primary care physicians, and 95,782 (10.7%) consulted pulmonologists. By comparison, 736,496 (82.3%) saw other specialists, and 218,997 (24.5%) saw cardiologists. There were 32,473 individuals (3.6%) who underwent COPD-related hospitalizations. Of those in the subcohort with one hospitalization, about 30.0% saw pulmonologists; 43.7% of those who underwent two or more hospitalizations saw pulmonologists, and 9.9% with no hospitalization consulted pulmonologists.
Primary care physicians play a substantial role in caring for patients with COPD. But only one-half as many patients with COPD saw pulmonologists than cardiologists, suggesting that COPD may receive less specialty care compared with other chronic medical conditions. This information can help inform COPD care strategies to improve COPD care and minimize exacerbations and associated health-care costs. It also suggests a need for more research to provide guidance on when patients with COPD should be referred to pulmonologists.
目前对于 COPD 患者中有多少比例从初级保健医生、肺科医生或其他专科医生那里获得门诊护理的了解有限。我们评估了为 COPD 患者提供门诊护理的医生类型和组合。
我们使用加拿大安大略省的健康管理数据集进行了一项基于人群的横断面研究，时间范围为 2014 年 4 月 1 日至 2015 年 3 月 31 日。使用以前验证过的 COPD 病例定义，确定年龄在 35 岁及以上且有医生诊断的 COPD 的个体。主要结局是在 1 年内进行初级保健医生、肺科医生和所有其他专科医生的门诊就诊。
共确定了 895155 名有医生诊断的 COPD 患者。其中，56533 名（6.3%）没有门诊就诊，802327 名（89.6%）看了初级保健医生，95782 名（10.7%）看了肺科医生。相比之下，736496 名（82.3%）看了其他专科医生，218997 名（24.5%）看了心脏病专家。有 32473 名（3.6%）患者进行了 COPD 相关的住院治疗。在有一次住院治疗的亚组中，约 30.0%的患者看了肺科医生；有两次或更多次住院治疗的患者中，43.7%的患者看了肺科医生，而没有住院治疗的患者中有 9.9%看了肺科医生。
初级保健医生在照顾 COPD 患者方面发挥了重要作用。但是，看肺科医生的 COPD 患者人数仅为看心脏病专家的一半，这表明与其他慢性疾病相比，COPD 可能接受的专科护理较少。这些信息可以帮助制定 COPD 护理策略，以改善 COPD 护理并最大限度地减少恶化和相关的医疗保健费用。这也表明需要进行更多的研究，以提供有关何时应将 COPD 患者转介给肺科医生的指导。
