肺炎住院后初级保健咨询：一项基于人群的大型队列研究。

Primary care consultations after hospitalisation for pneumonia: a large population-based cohort study.

机构信息

Department of Respiratory Medicine, Nottingham University Hospital NHS Trust; clinical research fellow, Faculty of Medicine and Health Sciences, University of Nottingham; National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham.

Faculty of Medicine and Health Sciences, University of Nottingham; NIHR Nottingham Biomedical Research Centre, Nottingham.

出版信息

Br J Gen Pract. 2021 Mar 26;71(705):e250-e257. doi: 10.3399/BJGP.2020.0890. Print 2021 Apr.

DOI:10.3399/BJGP.2020.0890

PMID:33753348

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8007276/

Abstract

BACKGROUND

Up to 70% of patients report ongoing symptoms 4 weeks after hospitalisation for pneumonia; the impact on primary care is poorly understood.

AIM

To investigate the frequency of primary care consultations after hospitalisation for pneumonia, and the reasons for consultation.

DESIGN AND SETTING

A population-based cohort study in England using a UK primary care database of anonymised medical records (Clinical Practice Research Datalink [CPRD]) linked to Hospital Episode Statistics (HES).

METHOD

Adults with the first International Classification of Diseases, 10th Revision (ICD-10) code for pneumonia (J12-J18) recorded in HES between July 2002 and June 2017 were included. Primary care consultation within 30 days of discharge was identified as the recording of any medical Read code (excluding administration-related codes) in CPRD. Competing-risks regression analyses were conducted to determine the predictors of consultation and antibiotic use at consultation; death and readmission were competing events. Reasons for consultation were examined.

RESULTS

Of 56 396 adults, 55.9% ( = 31 542) consulted primary care within 30 days of hospital discharge. The rate of consultation was highest within 7 days (4.7 per 100 person-days). The strongest predictor for consultation was a higher number of primary care consultations in the year before index admission (adjusted subhazard ratio [sHR] 8.98, 95% confidence interval [CI] = 6.42 to 12.55). The most common reason for consultation was for a respiratory disorder (40.7%, = 12 840), 11.8% for pneumonia specifically. At consultation, 31.1% ( = 9823) received further antibiotics. Penicillins (41.6%, = 5753/13 829) and macrolides (21.9%, = 3029/13 829) were the most common antibiotics prescribed.

CONCLUSION

Following hospitalisation for pneumonia, a significant proportion of patients consulted primary care within 30 days, highlighting the morbidity experienced by patients during recovery from pneumonia.

摘要

背景

多达 70%的肺炎住院患者在出院后 4 周仍有持续症状；但其对基层医疗的影响尚未可知。

目的

调查肺炎住院患者出院后基层医疗就诊的频率及其就诊原因。

设计和设置

本研究为一项基于人群的队列研究，使用英国基层医疗数据库（临床实践研究数据链接 [CPRD]）对匿名医疗记录进行分析，该数据库与医院入院统计数据（HES）相链接。

方法

纳入 2002 年 7 月至 2017 年 6 月期间 HES 中记录的首个国际疾病分类，第 10 版（ICD-10）肺炎编码（J12-J18）的成年人。出院后 30 天内的基层医疗就诊是指 CPRD 中记录的任何医疗 Read 代码（不包括与管理相关的代码）。采用竞争风险回归分析确定就诊和就诊时使用抗生素的预测因素；死亡和再次入院是竞争事件。并对就诊原因进行了分析。

结果

在 56396 名成年人中，55.9%（ = 31542）在出院后 30 天内就诊于基层医疗。就诊率在 7 天内最高（每 100 人日就诊 4.7 次）。就诊的最强预测因素是指数入院前一年内的基层医疗就诊次数更多（校正亚危险比 [sHR] 8.98，95%置信区间 [CI] = 6.42 至 12.55）。就诊最常见的原因是呼吸系统疾病（40.7%， = 12840），专门针对肺炎的为 11.8%。就诊时，31.1%（ = 9823）的患者接受了进一步的抗生素治疗。青霉素（41.6%， = 5753/13829）和大环内酯类药物（21.9%， = 3029/13829）是最常用的抗生素。