Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho, South Korea.
Sci Rep. 2020 Apr 8;10(1):6049. doi: 10.1038/s41598-020-63064-x.
Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory airway disease requiring frequent outpatient visits and lifelong management. We aimed to evaluate the roles of frequent outpatient visits in prognosis of COPD. We used claims data in the national medical insurance review system provided by the Health Insurance Review and Assessment Service of Korea from May 1, 2014 to April 30, 2015. A definition of COPD was used based on the diagnosis code and medication. Frequent visitors were defined as subjects who visited the outpatient clinic for COPD three or more times per year. Among 159,025 subjects, 117,483 (73.9%) were classified as frequent visitors. Frequent visitors underwent pulmonary function tests and used various inhalers more often than did infrequent visitors. The rates of COPD exacerbation requiring admission to a general ward, emergency room, or intensive care unit were significantly lower in frequent visitors than in infrequent visitors. In multivariable analysis, frequent visits were identified as an independent factor preventing COPD exacerbation that required admission to a ward (odds ratio [OR], 0.387), emergency room, (OR, 0.558), or intensive care unit (OR, 0.39) (all P < 0.001). In conclusion, we showed frequent outpatient visits reduce the risk of COPD exacerbation by 45-60%.
慢性阻塞性肺疾病（COPD）是一种慢性炎症性气道疾病，需要频繁的门诊就诊和终身管理。我们旨在评估频繁门诊就诊对 COPD 预后的作用。我们使用了韩国健康保险审查与评估服务机构提供的国家医疗保险审查系统中的索赔数据，时间范围为 2014 年 5 月 1 日至 2015 年 4 月 30 日。根据诊断代码和药物使用情况，定义了 COPD。频繁就诊者定义为每年因 COPD 就诊门诊 3 次或以上的患者。在 159025 名患者中，有 117483 名（73.9%）被归类为频繁就诊者。与非频繁就诊者相比，频繁就诊者更频繁地进行肺功能检查和使用各种吸入器。需要住院、急诊或重症监护病房治疗的 COPD 加重率在频繁就诊者中明显低于非频繁就诊者。在多变量分析中，频繁就诊被确定为预防需要住院（优势比 [OR]，0.387）、急诊（OR，0.558）或重症监护病房（OR，0.39）治疗的 COPD 加重的独立因素（所有 P < 0.001）。总之，我们表明频繁的门诊就诊可将 COPD 加重的风险降低 45-60%。
