scholarly journals Impact of COVID-19 on Hospital Admissions for COPD Exacerbation: Lessons for Future Care

Medicina ◽  
2022 ◽  
Vol 58 (1) ◽  
pp. 66
Author(s):  
Michael Lawless ◽  
Mark Burgess ◽  
Stephen Bourke
Keyword(s):  
Hospital Admissions ◽  
Matched Control ◽  
Control Period ◽  
Substantial Reduction ◽  
Chronic Obstructive ◽  
Post Discharge ◽  
Obstructive Pulmonary Disease ◽  
North East ◽  
The North ◽  
Future Care

Background and Objectives: Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide. Acute exacerbations (AECOPD) are common and often triggered by viral infection. During the COVID-19 pandemic social restrictions, including ‘shielding’ and ‘lockdowns’, were mandated. Multiple, worldwide studies report a reduction in AECOPD admissions during this period. This study aims to assess the effect of the pandemic and Lockdown on the rates of admission with AECOPD and severity of hospitalised exacerbations in the North-East of England. Materials and Methods: Data were extracted for patients presenting with a diagnosis of AECOPD or respiratory failure secondary to AECOPD during the ‘COVID-19 period’ (26/3/20–31/12/20) and a date-matched control period from the year previous. We present descriptive statistics and regression analysis of the effects of the COVID-19 period on the rates of hospital admission. Results: Compared to the matched control period, the COVID-19 period was associated with fewer AECOPD admissions (COVID-19 = 719, control = 1257; rate ratio 0.57, p < 0.001) and shorter length of stay (COVID-19 = 3.9 ± 0.2, control = 4.78 ± 0.2 days; p = 0.002), with similar in-hospital plus 30-day post-discharge mortality. Demographics were similar between periods. Only six patients had a positive COVID-19 PCR test. Conclusion: During the COVID-19 period there was a substantial reduction in AECOPD admissions, but no increase in overall severity of exacerbations or mortality. Rather than fear driving delayed hospital presentation, physical and behavioural measures taken during this period to limit transmission of COVID-19 are likely to have reduced transmission of other respiratory viruses. This has important implications for control of future AECOPD.

scholarly journals Supported self-management for patients with moderate to severe chronic obstructive pulmonary disease (COPD): an evidence synthesis and economic analysis

2015 ◽  
Vol 19 (36) ◽  
pp. 1-516 ◽  
Author(s):  
Rachel E Jordan ◽  
Saimma Majothi ◽  
Nicola R Heneghan ◽  
Deirdre B Blissett ◽  
Richard D Riley ◽  
...  
Keyword(s):  
Systematic Review ◽  
Conference Proceedings ◽  
Economic Model ◽  
Hospital Admissions ◽  
Meta Analysis ◽  
Chronic Obstructive ◽  
Controlled Trials ◽  
Post Discharge ◽  
Obstructive Pulmonary Disease

BackgroundSelf-management (SM) support for patients with chronic obstructive pulmonary disease (COPD) is variable in its coverage, content, method and timing of delivery. There is insufficient evidence for which SM interventions are the most effective and cost-effective.ObjectivesTo undertake (1) a systematic review of the evidence for the effectiveness of SM interventions commencing within 6 weeks of hospital discharge for an exacerbation for COPD (review 1); (2) a systematic review of the qualitative evidence about patient satisfaction, acceptance and barriers to SM interventions (review 2); (3) a systematic review of the cost-effectiveness of SM support interventions within 6 weeks of hospital discharge for an exacerbation of COPD (review 3); (4) a cost-effectiveness analysis and economic model of post-exacerbation SM support compared with usual care (UC) (economic model); and (5) a wider systematic review of the evidence of the effectiveness of SM support, including interventions (such as pulmonary rehabilitation) in which there are significant components of SM, to identify which components are the most important in reducing exacerbations, hospital admissions/readmissions and improving quality of life (review 4).MethodsThe following electronic databases were searched from inception to May 2012: MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Science Citation Index [Institute of Scientific Information (ISI)]. Subject-specific databases were also searched: PEDro physiotherapy evidence database, PsycINFO and the Cochrane Airways Group Register of Trials. Ongoing studies were sourced through themetaRegister of Current Controlled Trials, International Standard Randomised Controlled Trial Number database, World Health Organization International Clinical Trials Registry Platform Portal and ClinicalTrials.gov. Specialist abstract and conference proceedings were sourced through ISI’s Conference Proceedings Citation Index and British Library’s Electronic Table of Contents (Zetoc). Hand-searching through European Respiratory Society, the American Thoracic Society and British Thoracic Society conference proceedings from 2010 to 2012 was also undertaken, and selected websites were also examined. Title, abstracts and full texts of potentially relevant studies were scanned by two independent reviewers. Primary studies were included if ≈90% of the population had COPD, the majority were of at least moderate severity and reported on any intervention that included a SM component or package. Accepted study designs and outcomes differed between the reviews. Risk of bias for randomised controlled trials (RCTs) was assessed using the Cochrane tool. Random-effects meta-analysis was used to combine studies where appropriate. A Markov model, taking a 30-year time horizon, compared a SM intervention immediately following a hospital admission for an acute exacerbation with UC. Incremental costs and quality-adjusted life-years were calculated, with sensitivity analyses.ResultsFrom 13,355 abstracts, 10 RCTs were included for review 1, one study each for reviews 2 and 3, and 174 RCTs for review 4. Available studies were heterogeneous and many were of poor quality. Meta-analysis identified no evidence of benefit of post-discharge SM support on admissions [hazard ratio (HR) 0.78, 95% confidence interval (CI) 0.52 to 1.17], mortality (HR 1.07, 95% CI 0.74 to 1.54) and most other health outcomes. A modest improvement in health-related quality of life (HRQoL) was identified but this was possibly biased due to high loss to follow-up. The economic model was speculative due to uncertainty in impact on readmissions. Compared with UC, post-discharge SM support (delivered within 6 weeks of discharge) was more costly and resulted in better outcomes (£683 cost difference and 0.0831 QALY gain). Studies assessing the effect of individual components were few but only exercise significantly improved HRQoL (3-month St George’s Respiratory Questionnaire 4.87, 95% CI 3.96 to 5.79). Multicomponent interventions produced an improved HRQoL compared with UC (mean difference 6.50, 95% CI 3.62 to 9.39, at 3 months). Results were consistent with a potential reduction in admissions. Interventions with more enhanced care from health-care professionals improved HRQoL and reduced admissions at 1-year follow-up. Interventions that included supervised or unsupervised structured exercise resulted in significant and clinically important improvements in HRQoL up to 6 months.LimitationsThis review was based on a comprehensive search strategy that should have identified most of the relevant studies. The main limitations result from the heterogeneity of studies available and widespread problems with their design and reporting.ConclusionsThere was little evidence of benefit of providing SM support to patients shortly after discharge from hospital, although effects observed were consistent with possible improvement in HRQoL and reduction in hospital admissions. It was not easy to tease out the most effective components of SM support packages, although interventions containing exercise seemed the most effective. Future work should include qualitative studies to explore barriers and facilitators to SM post exacerbation and novel approaches to affect behaviour change, tailored to the individual and their circumstances. Any new trials should be properly designed and conducted, with special attention to reducing loss to follow-up. Individual participant data meta-analysis may help to identify the most effective components of SM interventions.Study registrationThis study is registered as PROSPERO CRD42011001588.FundingThe National Institute for Health Research Health Technology Assessment programme.

scholarly journals Study of potentially preventable hospitalisations (PPH) for chronic conditions: what proportion are preventable and what factors are associated with preventable PPH?

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e038415
Author(s):  
Jennifer Johnston ◽  
Jo Longman ◽  
Dan Ewald ◽  
Jonathan King ◽  
Sumon Das ◽  
...  
Keyword(s):  
Chronic Conditions ◽  
Hospital Admissions ◽  
Medication Management ◽  
Community Dwelling ◽  
Living Alone ◽  
Chronic Obstructive ◽  
Discharge Diagnosis ◽  
Obstructive Pulmonary Disease ◽  
Factors Associated ◽  
Study Sites

IntroductionThe proportion of potentially preventable hospitalisations (PPH) which are actually preventable is unknown, and little is understood about the factors associated with individual preventable PPH. The Diagnosing Potentially Preventable Hospitalisations (DaPPHne) Study aimed to determine the proportion of PPH for chronic conditions which are preventable and identify factors associated with chronic PPH classified as preventable.SettingThree hospitals in NSW, Australia.ParticipantsCommunity-dwelling patients with unplanned hospital admissions between November 2014 and June 2017 for congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes complications or angina pectoris. Data were collected from patients, their general practitioners (GPs) and hospital records.Outcome measuresAssessments of the preventability of each admission by an Expert Panel.Results323 admissions were assessed for preventability: 46% (148/323) were assessed as preventable, 30% (98/323) as not preventable and 24% (77/323) as unclassifiable. Statistically significant differences in proportions preventable were found between the three study sites (29%; 47%; 58%; p≤0.001) and by primary discharge diagnosis (p≤0.001).Significant predictors of an admission being classified as preventable were: study site; final principal diagnosis of CHF; fewer diagnoses on discharge; shorter hospital stay; GP diagnosis of COPD; GP consultation in the last 12 months; not having had a doctor help make the decision to go to hospital; not arriving by ambulance; patient living alone; having someone help with medications and requiring help with daily tasks.ConclusionsThat less than half the chronic PPH were assessed as preventable, and the range of factors associated with preventability, including site and discharge diagnosis, are important considerations in the validity of PPH as an indicator. Opportunities for interventions to reduce chronic PPH include targeting patients with CHF and COPD, and the provision of social welfare and support services for patients living alone and those requiring help with daily tasks and medication management.

scholarly journals Trends in Hospital Admissions for Chronic Obstructive Pulmonary Disease in Men and Women in SPAIN, 1998 to 2018

2021 ◽  
Vol 10 (7) ◽  
pp. 1529
Author(s):  
Domingo Orozco-Beltrán ◽  
Juan Manuel Arriero-Marin ◽  
Concepción Carratalá-Munuera ◽  
Juan J. Soler-Cataluña ◽  
Adriana Lopez-Pineda ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Hospital Admissions ◽  
Chronic Obstructive ◽  
Annual Percent Change ◽  
Data Set ◽  
Obstructive Pulmonary Disease ◽  
Men And Women ◽  
Admission Rates ◽  
Percent Change

The prevalence of chronic obstructive pulmonary disease (COPD) is rising faster in women in some countries. An observational time trends study was performed to assess the evolution of hospital admissions for COPD in men and women in Spain from 1998 to 2018. ICD-9 diagnostic codes (490–492, 496) from the minimum basic data set of hospital discharges were used. Age-standardised admission rates were calculated using the European Standard Population. Joinpoint regression models were fitted to estimate the annual percent change (APC). In 2018, the age-standardised admission rate per 100,000 population/year for COPD was five times higher in men (384.8, 95% CI: 381.7, 387.9) than in women (78.6, 95% CI: 77.4, 79.9). The average annual percent change (AAPC) was negative over the whole study period in men (−1.7%/year, 95% CI: −3.1, −0.2) but positive from 2010 to 2018 (1.1%/year, 95% CI: −0.8, 2.9). In women, the APC was −6.0% (95%CI: −7.1, −4.9) from 1998 to 2010, but the trend reversed direction in the 2010–2018 period (7.8%/year, 95% CI: 5.5, 10.2). Thus, admission rates for COPD decreased from 1998 to 2010 in both men and women but started rising again until 2018, modestly in men and sharply in women.

scholarly journals Symptomatic Patent Foramen Ovale with Hemidiaphragm Paralysis

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Hussain Ibrahim ◽  
Adnan Khan ◽  
Shawn P. Nishi ◽  
Ken Fujise ◽  
Syed Gilani
Keyword(s):  
Right Atrium ◽  
Chronic Conditions ◽  
Patent Foramen Ovale ◽  
Hospital Admissions ◽  
Clinical Suspicion ◽  
Chronic Obstructive ◽  
Foramen Ovale ◽  
Obstructive Pulmonary Disease ◽  
Benign Condition ◽  
High Clinical Suspicion

Dyspnea accounts for more than one-fourth of the hospital admissions from Emergency Department. Chronic conditions such as Chronic Obstructive Pulmonary Disease, Congestive Heart Failure, and Asthma are being common etiologies. Less common etiologies include conditions such as valvular heart disease, pulmonary embolism, and right-to-left shunt (RLS) from patent foramen ovale (PFO). PFO is present in estimated 20–30% of the population, mostly a benign condition. RLS via PFO usually occurs when right atrium pressure exceeds left atrium pressure. RLS can also occur in absence of higher right atrium pressure. We report one such case that highlights the importance of high clinical suspicion, thorough evaluation, and percutaneous closure of the PFO leading to significant improvement in the symptoms.

scholarly journals Reducing hospital admissions for COPD: perspectives following the Christchurch Earthquake

2018 ◽  
Vol 5 (1) ◽  
pp. e000286 ◽  
Author(s):  
Michael Epton ◽  
Carol Limber ◽  
Carolyn Gullery ◽  
Graham McGeoch ◽  
Brett Shand ◽  
...  
Keyword(s):  
Community Care ◽  
Hospital Admissions ◽  
Healthcare Delivery ◽  
Care Process ◽  
Chronic Obstructive ◽  
Process Of Change ◽  
Obstructive Pulmonary Disease ◽  
Healthcare Environment ◽  
Christchurch Hospital ◽  
Subsequent Response

The devastating 2011 earthquake in Christchurch destroyed or badly damaged healthcare infrastructure, including Christchurch Hospital. This forced change in management of exacerbations of chronic obstructive pulmonary disease (COPD), which until that point had frequently led to admission to hospital and focused attention on providing safe community options for care. This paper describes the process of understanding factors contributing to high admission frequency with exacerbations of COPD and also describes a process of change, predominantly to healthcare delivery systems and philosophies, and the subsequent outcomes. What became clear in understanding admissions with COPD to Christchurch Hospital was that the behaviour of the patient, in the context of exacerbations, and the subsequent response of the system to the patient, led to admission being the default option, in spite of low severity of the exacerbation itself. By altering systems’ responses to exacerbations, with a linked care process between ambulances, community care and hospitals, we were able to safely reduce admissions for COPD, with a sustained overall reduction in bed-day occupancy for COPD of ~48%. We would encourage these discussions and changes to occur without the stimulus of an earthquake in your healthcare environment!

scholarly journals A study of clinical/biological markers of exacerbation/progression in a cohort of patients admitted with acute excerbation of COPD

2018 ◽  
Vol 5 (1) ◽  
pp. 32
Author(s):  
Shivraj A. L. ◽  
Prakash B.
Keyword(s):  
Hospital Admissions ◽  
Chronic Obstructive ◽  
Clinical Markers ◽  
Significant Drop ◽  
Obstructive Pulmonary Disease ◽  
Protein Levels ◽  
Related Quality ◽  
Frequent Exacerbation ◽  
A Prospective Study

Background:Exacerbations of chronic obstructive pulmonary disease increases the morbidity, hospital admissions, mortality, and strongly influence health-related quality of life. The aims of this study to know the Clinical profile of COPD and acute exacerbation, Role of clinical markers in diagnosis and follow up of exacerbation.Methods: A prospective study of a cohort of 60 patients hospitalized for AECOPD was undertaken to identify markers for frequent exacerbation and progression of disease. Advised to fill the SGRQ questionnaire, At the time of discharge 6MWT done and analyzed. C Reactive protein levels at the time of admission done and analyzed. Sputum grams stain culture, total counts and differential counts done and analyzed. At the time of discharge spirometry done both pre and post bronchodilators by using asthalin inhaler with or without spacer, results were analyzed.Results:There was statistically significant drop in the SPO2 levels in frequent exacerbators over 6 months follow up time. There was statistically significant elevation of sputum Neutrophil counts in frequent exacerbators and Eosinophil counts in infrequent exacerbators, there was a drop in the CRP levels of from the time of initial exacerbation to 6 months follow up time. There was statistically significant drop in FEV1 in frequent exacerbators over 6 months follow up study. The drop of 6MWT was more in patients, who had frequent exacerbations.Conclusions:Patients with more frequent exacerbation have more symptoms, drop in the saturation level and have more sputum neutrophil counts. Patients with more frequent exacerbations will have more deterioration of lung functions (FEV1.6MWT).

scholarly journals Program of Integrated Care for Patients with Chronic Obstructive Pulmonary Disease and Multiple Comorbidities (PIC COPD+): a randomised controlled trial

2018 ◽  
Vol 51 (1) ◽  
pp. 1701567 ◽  
Author(s):  
Louise Rose ◽  
Laura Istanboulian ◽  
Lise Carriere ◽  
Anna Thomas ◽  
Han-Byul Lee ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hospital Admissions ◽  
Controlled Trial ◽  
Case Manager ◽  
Emergency Department Visits ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Secondary Outcomes ◽  
Randomised Controlled ◽  
Component Case

We sought to evaluate the effectiveness of a multi-component, case manager-led exacerbation prevention/management model for reducing emergency department visits. Secondary outcomes included hospitalisation, mortality, health-related quality of life, chronic obstructive pulmonary disease (COPD) severity, COPD self-efficacy, anxiety and depression.Two-centre randomised controlled trial recruiting patients with ≥2 prognostically important COPD-associated comorbidities. We compared our multi-component intervention including individualised care/action plans and telephone consults (12-weekly then 9-monthly) with usual care (both groups). We used zero-inflated Poisson models to examine emergency department visits and hospitalisation; Cox proportional hazard model for mortality.We randomised 470 participants (236 intervention, 234 control). There were no differences in number of emergency department visits or hospital admissions between groups. We detected difference in emergency department visit risk, for those that visited the emergency department, favouring the intervention (RR 0.74, 95% CI 0.63–0.86). Similarly, risk of hospital admission was lower in the intervention group for those requiring hospital admission (RR 0.69, 95% CI 0.54–0.88). Fewer intervention patients died (21 versus 36) (HR 0.56, 95% CI 0.32–0.95). No differences were detected in other secondary outcomes.Our multi-component, case manager-led exacerbation prevention/management model resulted in no difference in emergency department visits, hospital admissions and other secondary outcomes. Estimated risk of death (intervention) was nearly half that of the control.

scholarly journals Impact of community-based chronic obstructive pulmonary disease service, a multidisciplinary intervention in an area of high deprivation: a longitudinal matched controlled study

BMJ Open ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. e032931
Author(s):  
Pooja Saini ◽  
Tanith Rose ◽  
Jennifer Downing ◽  
Bashir Matata ◽  
Samantha Pilsworth ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Hospital Admissions ◽  
Controlled Study ◽  
Control Group ◽  
Chronic Obstructive ◽  
Community Based ◽  
Obstructive Pulmonary Disease ◽  
Emergency Hospital ◽  
Emergency Hospital Admissions

ObjectiveTo examine the effects of a consultant-led, community-based chronic obstructive pulmonary disease (COPD) service, based in a highly deprived area on emergency hospital admissions.DesignA longitudinal matched controlled study using difference-in-differences analysis to compare the change in outcomes in the intervention population to a matched comparison population, 5 years before and after implementation.SettingA deprived district in the North West of England between 2005 and 2016.InterventionA community-based, consultant-led COPD service providing diagnostics, treatment and rehabilitation from 2011 to 2016.Main outcome measuresEmergency hospital admissions, length of stay per emergency admission and emergency readmissions for COPD.ResultsThe intervention was associated with 24 fewer emergency COPD admissions per 100 000 population per year (95% CI −10.6 to 58.8, p=0.17) in the postintervention period, relative to the control group. There were significantly fewer emergency admissions in populations with medium levels of deprivation (64 per 100 000 per year; 95% CI 1.8 to 126.9) and among men (60 per 100 000 per year; 95% CI 12.3 to 107.3).ConclusionWe found limited evidence that the service reduced emergency hospital admissions, after an initial decline the effect was not sustained. The service, however, may have been more effective in some subgroups.

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