Jo Yong Suk, Yoo Kwang Ha, Park Yong Bum, Rhee Chin Kook, Jung Ki Suck, Jang Seung Hun, Park Ji Young, Kim Youlim, Kim Bo Yeon, Ahn Sang In, Jo Yon U, Hwang Yong Il
Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea.
Lung Research Institute of Hallym University College of Medicine, Chuncheon, South Korea.
Int J Chron Obstruct Pulmon Dis. 2020 Jun 12;15:1367-1375. doi: 10.2147/COPD.S248616. eCollection 2020.
Maintaining adequacy in chronic obstructive pulmonary disease (COPD) care is essential to sustain an adequate level of care. We aimed to assess the current status of COPD quality control and the influence of inhaler changes on disease-related health care utilization.
The Health Insurance Review and Assessment Service (HIRA) nationwide database for reimbursed insurance claims from all medical institutions in South Korea from May 2014 to April 2017 was investigated. COPD care quality was assessed by the performance rate of spirometry, the percentage of persistent visit patients and patients prescribed a bronchodilator. The number of severe exacerbations was evaluated.
A total of 68,942 COPD patients were included for 3 years of longitudinal analyses. The overall spirometry enforcement rate was just over 50%, the percentage of regular follow-up patients was over 85%, and bronchodilators were prescribed to over 80% of the patients. COPD-related hospitalization or ER visit rates were 16.6%, 15.3%, and 17.8% for three consequent assessments, respectively. Inhaler changes were analyzed between the first and second assessments: 57.1% were maintained, 0.4% were changed to another class, 9% were escalated, and 5.2% were de-escalated. Only in the escalated group, especially those who changed from the mono to dual inhaler and dual to triple inhaler, had fewer hospitalizations or ER visits.
Adequacy of COPD care status was not that high considering the low-enforcement rate of spirometry, but most patients were prescribed a bronchodilator and regularly followed up. Those who escalated inhaler treatment experienced less health care utilization.
在慢性阻塞性肺疾病（COPD）护理中维持适当水平对于持续提供充分的护理至关重要。我们旨在评估COPD质量控制的现状以及吸入器更换对疾病相关医疗保健利用的影响。
对韩国健康保险审查与评估服务机构（HIRA）的全国数据库进行了调查，该数据库涵盖了2014年5月至2017年4月期间韩国所有医疗机构报销的保险理赔数据。通过肺活量测定的执行率、持续就诊患者的百分比以及开具支气管扩张剂的患者百分比来评估COPD护理质量。评估了严重加重发作的次数。
共有68942例COPD患者纳入了为期3年的纵向分析。肺活量测定的总体执行率略高于50%，定期随访患者的百分比超过85%，超过80%的患者开具了支气管扩张剂。在连续三次评估中，COPD相关的住院率或急诊就诊率分别为16.6%、15.3%和17.8%。对第一次和第二次评估之间的吸入器更换情况进行了分析：57.1%的患者维持原状，0.4%的患者更换为另一类吸入器，9%的患者升级，5.2%的患者降级。只有在升级组中，尤其是那些从单剂量吸入器更换为双剂量吸入器以及从双剂量吸入器更换为三剂量吸入器的患者，住院或急诊就诊次数较少。
考虑到肺活量测定的低执行率，COPD护理状况的适当性并不高，但大多数患者都开具了支气管扩张剂并接受了定期随访。吸入器治疗升级的患者医疗保健利用率较低。
