Health Care Utilisation and Health Needs of People with Severe COPD in the Southern Region of New Zealand: A Retrospective Case Note Review. (3rd March 2020)

• Record Type: Journal Article
• Authors: Dummer, Jack; Tumilty, Emma; Hannah, Debbie; McAuley, Kathryn; Baxter, Jo; Doolan-Noble, Fiona; Donlevy, Simon; Stokes, Tim
• Is Part Of: COPD. Volume 17:Number 2(2020)
• Page Start: 136
• Page End: 142
• Publication Date: 2020-03-03
• Subjects: Chronic obstructive pulmonary disease -- health systems service delivery -- pulmonary rehabilitation; Lungs -- Diseases, Obstructive -- Periodicals; 616.24
• DOI: 10.1080/15412555.2020.1724275
• Languages: English
• ISSNs: 1541-2555

Abstract

Abstract: We examined health care utilisation and needs of people with severe COPD in the low-population-density setting of the Southern Region of New Zealand (NZ). We undertook a retrospective case note review of patients with COPD coded as having an emergency department attendance and/or admission with at least one acute exacerbation during 2015 to hospitals in the Southern Region of NZ. Data were collected and analysed from 340 case notes pertaining to: demographics, hospital admissions, outpatient contacts, pulmonary rehabilitation, advance care planning and comorbidities. Geometric mean (95%CI) length of stay for hospital admissions in urban and rural hospitals was 3.0 (2.7-3.4) and 4.0 (2.9-5.4) days respectively. More patients were from areas of higher deprivation but median hospital length of stay for patients from the least deprived areas was 2.0 days longer than others ( p = 0.04). There was a median of 4 (range 0-16) comorbidities and 10 medications (range 0-25) per person. Of 169 cases where data was available, 26 (15%) were offered, 17 (10%) declined, and 5 (3%) completed, pulmonary rehabilitation at or in the year prior to the index admission. Patients were less likely to be offered pulmonary rehabilitation if they lived >20km away from the hospital where it took place (odds ratio of 0.12 for those living further away [95%CI 0.02-0.93, p = 0.04]). There were deficits in care: provision and uptake of non-pharmacological interventions was suboptimal and unevenly distributed across the region. Further research is needed to develop and evaluate strategies for delivering non-pharmacological interventions in this setting.