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COPD: Health Care Utilisation Patterns with Different Disease Management Interventions

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Abstract

Purpose

The management of COPD is a significant and costly issue worldwide, with acute healthcare utilisation consisting of admissions and outpatient attendances being a major contributor to the cost. Pulmonary rehabilitation (PR) and integrated disease management (IDM) are often offered. Whilst there is strong evidence of physical and quality of life outcomes following IDM and PR, few studies have looked into healthcare utilisation. The aims of this study were to confirm whether IDM and PR reduce acute healthcare utilisation and to identify factors which contribute to acute health care utilisation or increased mortality.

Methods

This was a retrospective cohort study of patients with COPD who were referred to IDM over a 10-year period. Patients were also offered an 8-week PR program. Data collected were matched with the hospital dataset to obtain information on inpatient, ED and outpatient attendances.

Results

517 patients were enrolled to IDM. 315 (61%) also commenced PR and 220 (43%) completed PR. Patients who were referred to PR were younger and had less comorbidities (p < 0.001). Both groups (IDM only and IDM + PR referred) had reductions in healthcare utilisation but the IDM-only group had greater reductions. A survival benefit (HR 0.68, 95% CI 0.50–0.92) was seen in those who were PR completers compared to patients who received IDM only.

Conclusions

Patients with COPD who successfully complete PR in addition to participating in IDM have improved survival. IDM alone was effective in the reduction of healthcare utilisation; however, the addition of PR did not reduce healthcare usage further.

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Acknowledgements

We thank the team at Melbourne Easy Breathers and the RMH respiratory department for patient assessments.

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Authors and Affiliations

  1. Department of Rehabilitation, Royal Melbourne Hospital, Royal Park Campus 34 Poplar Road, Parkville, VIC, 3052, Australia

    Edwin K. Luk & Fary Khan

  2. Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia

    Edwin K. Luk, Mark Tacey, Louis Irving & Fary Khan

  3. Department of Respiratory Medicine & Sleep Disorders, Royal Melbourne Hospital, Parkville, VIC, Australia

    Anastasia F. Hutchinson & Louis Irving

  4. School of Nursing and Midwifery, Quality Patient Safety Research, Deakin University, Geelong, VIC, Australia

    Anastasia F. Hutchinson

  5. Melbourne EpiCentre, Royal Melbourne Hospital, Parkville, VIC, Australia

    Mark Tacey

  6. Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC, Australia

    Mark Tacey

  7. School of Public Health and Preventative Medicine, Monash University, Clayton, VIC, Australia

    Fary Khan

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  1. Edwin K. Luk
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  2. Anastasia F. Hutchinson
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Corresponding author

Correspondence to Edwin K. Luk.

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Conflict of interest

Dr Luk, Prof Hutchinson, Mr Tacey, Prof Irving and Prof Khan declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

For this type of study, formal consent is not required.

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Luk, E.K., Hutchinson, A.F., Tacey, M. et al. COPD: Health Care Utilisation Patterns with Different Disease Management Interventions. Lung 195, 455–461 (2017). https://doi.org/10.1007/s00408-017-0010-9

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  • DOI: https://doi.org/10.1007/s00408-017-0010-9

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