Respiratory Services, Te Whatu Ora, Waitaha Canterbury, New Zealand.
Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand.
Intern Med J. 2023 Oct;53(10):1768-1775. doi: 10.1111/imj.16204. Epub 2023 Aug 7.
During the year following New Zealand's first COVID-19 lockdown, a 33% reduction in chronic obstructive pulmonary disease (COPD)-related admissions occurred and persisted beyond this period at Christchurch Hospital.
To identify contributing factors which may have resulted in a persistent decrease in COPD hospitalisation rates at Christchurch Hospital following the 2020 COVID-19 lockdown.
Using an explanatory sequential mixed-methods research design, we (i) retrospectively analysed hospital admissions and primary healthcare access by people with COPD (n = 1358) in Canterbury before, during and after COVID lockdown (24 March 2019 to 2021) and (ii) undertook individual interviews from a sample of patients (n = 14).
Patients who were not re-admitted following the COVID-19 lockdown had fewer general practice encounters, acute primary care access, antibiotic and prednisone prescriptions. Proportionally fewer Māori and more Pacific patients were admitted with COPD following lockdown. Positive contributing factors at a primary care level included improvements in primary care interactions and medication management. At a patient and community level, there were improvements in lifestyle, self-management practices, social support and contact precautions. However, a subgroup of patients described negative effects such as social isolation.
A combination of patient, primary care and community-level factors led to an overall persistent decrease in COPD admissions following the COVID-19 lockdown. Future targeted and individualised measures focusing on these modifiable factors may decrease future COPD-related hospital admissions. The study design facilitated further explanation about factors that contributed to the persistent decrease in hospital admissions among people living with COPD and has underscored the importance of social support, patient empowerment and reduction in barriers in accessing care in admission reduction.
在新西兰首次实施 COVID-19 封锁后的一年中，克赖斯特彻奇医院（Christchurch Hospital）的慢性阻塞性肺疾病（COPD）相关入院率下降了 33%，并且在这一时期之后仍持续下降。
确定可能导致 2020 年 COVID-19 封锁后克赖斯特彻奇医院 COPD 住院率持续下降的因素。
使用解释性序贯混合方法研究设计，我们（i）回顾性分析了 COVID 封锁前后（2019 年 3 月 24 日至 2021 年）坎特伯雷地区 COPD 患者（n=1358）的医院入院和初级保健就诊情况，以及（ii）对来自患者样本（n=14）进行了个体访谈。
COVID-19 封锁后未再次入院的患者，其初级保健就诊次数、急性初级保健就诊次数、抗生素和泼尼松处方次数减少。封锁后，住院 COPD 患者中，毛利人和太平洋岛民患者的比例减少，而其他族裔患者的比例增加。初级保健层面的积极因素包括初级保健互动和药物管理的改善。在患者和社区层面，生活方式、自我管理实践、社会支持和接触预防措施有所改善。然而，有一小部分患者表示有负面的影响，如社交孤立。
患者、初级保健和社区层面的一系列因素共同导致 COVID-19 封锁后 COPD 入院率的持续下降。未来可能需要针对这些可改变因素制定有针对性和个体化的措施，以减少未来 COPD 相关的住院人数。研究设计有助于进一步解释导致 COVID-19 封锁后 COPD 患者住院人数持续下降的因素，并强调了社会支持、患者赋权以及减少获得护理障碍的重要性。
