Department of Medicine, Solna, Division of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden.
Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Solna, Sweden.
Int J Chron Obstruct Pulmon Dis. 2022 Aug 9;17:1769-1780. doi: 10.2147/COPD.S372266. eCollection 2022.
The Swedish guidelines recommend that patients with chronic obstructive pulmonary disease (COPD) on maintenance treatment are monitored annually, and within six weeks after an exacerbation. We describe the patterns of COPD-related visits in Sweden, both regular follow-up and post-exacerbation visits.
Patients (>40 years) with a first-time COPD diagnosis between 2006 and 2017 were identified in primary care medical records and linked to hospital contacts and administered drug data. The index date was defined as the first collection of inhaled COPD maintenance treatment after the diagnosis. Regular COPD visits within 15-months after the index, and post-exacerbation visits for COPD within six weeks and 15-months after an exacerbation were estimated using the cumulative incidence function adjusted for competing risk. Visits without a ICD code for COPD were not included in the analyses.
A total of 19,857 patients (mean age 69 years, 57% females) were included. The overall probability of having a regular follow-up visit for COPD within 15 months post-index was 39.1%. In total, 15,095 (76%) patients experienced at least one COPD exacerbation during the observation period. Among them, the probability of having a post-exacerbation visit was 7.0% within six weeks and 29.7% within 15-months. Patients without a regular COPD follow-up visit claimed significantly more oral corticosteroids (25.6% vs 15.6%), more respiratory antibiotics (39.1% vs 23.1%), and less maintenance treatment (10.9% vs 16.5%).
Only 39% of COPD patients attended a regular follow-up visit within 15-months from the COPD diagnosis and one-third had a post-exacerbation visit. The adherence to guideline recommendations need to be improved.
瑞典指南建议，接受慢性阻塞性肺疾病（COPD）维持治疗的患者应每年监测一次，并在病情加重后 6 周内监测。我们描述了瑞典 COPD 相关就诊的模式，包括常规随访和病情加重后就诊。
在初级保健医疗记录中确定了 2006 年至 2017 年间首次诊断为 COPD 的患者（年龄>40 岁），并与医院接触和药物管理数据相关联。索引日期定义为诊断后首次采集吸入性 COPD 维持治疗。使用竞争风险调整的累积发生率函数估计索引后 15 个月内的常规 COPD 就诊，以及病情加重后 6 周和 15 个月内的 COPD 就诊。没有 COPD ICD 代码的就诊不包括在分析中。
共纳入 19857 例患者（平均年龄 69 岁，57%为女性）。索引后 15 个月内常规 COPD 随访就诊的总体概率为 39.1%。在观察期间，共有 15095 例（76%）患者至少经历过一次 COPD 加重。其中，病情加重后 6 周内就诊的概率为 7.0%，15 个月内就诊的概率为 29.7%。未进行常规 COPD 随访就诊的患者显著更多地使用了口服皮质激素（25.6%比 15.6%）、更多的呼吸抗生素（39.1%比 23.1%）和更少的维持治疗（10.9%比 16.5%）。
只有 39%的 COPD 患者在 COPD 诊断后 15 个月内进行了常规随访就诊，三分之一的患者进行了病情加重后就诊。需要改进对指南建议的依从性。
