| Autor: |
Dummer J; Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.; Southern District Health Board, Respiratory Services, Dunedin Hospital, Dunedin, New Zealand., Tumilty E; Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand., Hannah D; Southern District Health Board, Respiratory Services, Dunedin Hospital, Dunedin, New Zealand., McAuley K; Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand., Baxter J; Kōhatu Centre for Hauora Māori, Division of Health Sciences, University of Otago, Dunedin, New Zealand., Doolan-Noble F; Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand., Donlevy S; Southern District Health Board, Respiratory Services, Dunedin Hospital, Dunedin, New Zealand., Stokes T; Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand. |
| Abstrakt: |
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. |
