Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway.
Department for Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway.
BMC Health Serv Res. 2024 Apr 22;24(1):500. doi: 10.1186/s12913-024-10975-4.
Although chronic obstructive pulmonary disease (COPD) admissions put a substantial burden on hospitals, most of the patients' contacts with health services are in outpatient care. Traditionally, outpatient care has been difficult to capture in population-based samples. In this study we describe outpatient service use in COPD patients and assess associations between outpatient care (contact frequency and specific factors) and next-year COPD hospital admissions or 90-day readmissions.
Patients over 40 years of age residing in Oslo or Trondheim at the time of contact in the period 2009-2018 were identified from the Norwegian Patient Registry (in- and outpatient hospital contacts, rehabilitation) and the KUHR registry (contacts with GPs, contract specialists and physiotherapists). These were linked to the Regular General Practitioner registry (characteristics of the GP practice), long-term care data (home and institutional care, need for assistance), socioeconomic and-demographic data from Statistics Norway and the Cause of Death registry. Negative binomial models were applied to study associations between combinations of outpatient care, specific care factors and next-year COPD hospital admissions and 90-day readmissions. The sample consisted of 24,074 individuals.
A large variation in the frequency and combination of outpatient service use for respiratory diagnoses (GP, emergency room, physiotherapy, contract specialist and outpatient hospital contacts) was apparent. GP and outpatient hospital contact frequency were strongly associated to an increased number of next-year hospital admissions (1.2-3.2 times higher by increasing GP frequency when no outpatient hospital contacts, 2.4-5 times higher in combination with outpatient hospital contacts). Adjusted for healthcare use, comorbidities and sociodemographics, outpatient care factors associated with lower numbers of next-year hospitalisations were fees indicating interaction between providers (7% reduction), spirometry with GP or specialist (7%), continuity of care with GP (15%), and GP follow-up (8%) or rehabilitation (18%) within 30 days vs. later following any current year hospitalisations. For 90-day readmissions results were less evident, and most variables were non-significant.
As increased use of outpatient care was strongly associated with future hospitalisations, this further stresses the need for good communication between providers when coordinating care for COPD patients. The results indicated possible benefits of care continuity within and interaction between providers.
虽然慢性阻塞性肺疾病（COPD）的住院治疗给医院带来了巨大的负担，但大多数患者与卫生服务的接触都是在门诊护理中。传统上，门诊护理很难在基于人群的样本中捕捉到。在这项研究中，我们描述了 COPD 患者的门诊服务使用情况，并评估了门诊护理（接触频率和特定因素）与下一年 COPD 住院或 90 天内再入院之间的关联。
从挪威患者登记处（门诊和住院医院接触、康复）和 KUHR 登记处（与全科医生、专科医生和物理治疗师的接触）中确定了在 2009-2018 年期间接触时居住在奥斯陆或特隆赫姆的 40 岁以上患者。这些患者与常规全科医生登记处（全科医生实践的特征）、长期护理数据（家庭和机构护理、需要帮助）、挪威统计局和死因登记处的社会经济和人口统计学数据相关联。应用负二项式模型研究了门诊护理、特定护理因素与下一年 COPD 住院和 90 天内再入院之间的组合之间的关联。样本包括 24074 人。
门诊服务用于呼吸诊断（全科医生、急诊室、物理治疗、专科医生和门诊医院接触）的频率和组合差异很大。全科医生和门诊医院接触频率与下一年住院人数的增加密切相关（当没有门诊医院接触时，增加全科医生频率可增加 1.2-3.2 倍，当与门诊医院接触时增加 2.4-5 倍）。调整医疗保健使用、合并症和社会人口统计学因素后，与下一年住院人数减少相关的门诊护理因素是表明提供者之间相互作用的费用（减少 7%）、与全科医生或专家一起进行的肺活量测定（减少 7%）、与全科医生的连续性护理（增加 15%），以及在任何当年住院后 30 天内与随后的任何当年住院相比，接受全科医生随访（增加 8%）或康复（增加 18%）。对于 90 天内再入院，结果不太明显，大多数变量没有统计学意义。
由于门诊护理的使用增加与未来住院治疗密切相关，因此这进一步强调了在协调 COPD 患者的护理时，提供者之间需要进行良好的沟通。结果表明提供者之间的连续性护理和相互作用可能具有益处。
