Comprehensive care plans for patients with Chronic Obstructive Pulmonary Disease (COPD): Effect on health services utilization

Abstract

RATIONALE

There is limited real-world evidence on evaluation of chronic disease management initiatives provided by general physicians to patients with chronic obstructive pulmonary disease (COPD).

OBJECTIVES

We aimed to evaluate changes in COPD-related healthcare resource utilization between COPD patients who had general physician’s provided comprehensive annual care plan (CACP) and those who did not have CACP.

METHODS

We conducted a retrospective cohort study using health administrative data (Alberta) from 2009 to 2016. COPD patients who received a CACP were identified and matched with two control patients based on age, sex, provider, date of service and qualifying comorbidities. Controlled interrupted-time series analysis was used to evaluate changes in COPD-specific hospitalizations, emergency department (ED) visits, physician visits and claims for pulmonary function test (PFT). Immediate and temporal changes were calculated for the difference in outcomes 1 year before and 1 year after receiving the CACP for the intervention group and matched controls.

RESULTS

Eligible patients (N = 88,002), of whom 35,847 had received CACPs were matched to a total of 52,155 controls. In 1 year after the CACPs implementation the number of COPD-related hospitalization visits significantly increased by 105.33 (95% CI 58.17-152.49), ED visits increased by 172.65 (95% CI 168.09–177.20), general practitioners (GP) visits increased by 359.53 (95% CI 247.64–471.41), specialist visits increased by 77.21 (95% CI 31.58–122.85) and PFT claims increased by 50.82 (95% CI 35.33–66.30) when compared to the controls who did not receive CACP per 10,000 patients per month. However, only increase in ED and specialist visits was confirmed by the sensitivity analysis.

CONCLUSIONS

Annual care plans provided by physicians were found to be associated with a statistically significant increase in COPD-related events (including ED visits) in the following year; however, clinical significance was minimal.

RÉSUMÉ

JUSTIFICATION

Il existe peu de données concrètes sur l'évaluation des initiatives de prise en charge des maladies chroniques offertes par les médecins généralistes aux patients atteints de MPOC.

OBJECTIFS

Nous avons cherché à évaluer les changements dans l'utilisation des ressources de santé liées à la MPOC chez les patients atteints de MPOC ayant bénéficié d'un plan de soins annuel complet offert par un médecin généraliste et ceux qui n'ont pas bénéficié d'un tel plan.

METHODES

Nous avons mené une étude de cohorte rétrospective à l’aide de données administratives de santé (Alberta) de 2009 à 2016. Les patients atteints de MPOC ayant bénéficié d’un plan de soins annuel complet ont été répertoriés et appariés à deux patients témoins en fonction de l'âge, du sexe, du prestataire, de la date de service et des comorbidités admissibles. Une analyse contrôlée de séries temporelles interrompues a été utilisée pour évaluer les changements dans les hospitalisations spécifiques à la MPOC, les visites aux urgences, les visites chez le médecin et les demandes de tests de la fonction pulmonaire (TFP). Les changements immédiats et temporels ont été calculés pour déterminer la différence dans les résultats un an avant et un an après avoir bénéficié d’un plan de soins annuel complet pour le groupe d'intervention et les témoins appariés.

RESULTATS

Les patients admissibles (N = 88 002), dont 35 847 avaient bénéficié d’un plan de soins annuels complet, ont été appariés à un total de 52 155 témoins. Un an après la mise en œuvre du plan, le nombre d'hospitalisations liées à la MPOC a augmenté de 105,33 (IC 58,17-152,49), les visites aux urgences ont augmenté de 172,65 (IC 168,09-177,20), les visites chez les médecins généralistes ont augmenté de 359,53 (IC 247,64-471,41), les consultations de spécialistes ont augmenté de 77,21 (IC 31,58-122,85) et les demandes de tests de la fonction pulmonaire ont augmenté de 50,82 (IC 35,33-66,30) par rapport aux témoins qui n'ont pas bénéficié d’un plan de soins annuel complet par 10 000 patients par mois. Cependant, seule l'augmentation des visites aux urgences et chez les spécialistes a été confirmée par l'analyse de sensibilité.

CONCLUSIONS

Les plans de soins annuels offerts par les médecins ont été associés à une augmentation statistiquement significative des événements liés à la MPOC (y compris les visites aux urgences) au cours de l'année suivante, mais la signification clinique était minime.

Keywords:

• Care plans
• chronic disease management
• COPD
• primary care

Acknowledgments

This study is based on data provided by Alberta Health. The interpretation and conclusions of the results are those of the researchers and do not necessarily represent the views of the government of Alberta nor the funder (M.S.I. Foundation).

Author contributions

T. Makhinova had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis and was responsible for the drafting of the manuscript and study supervision. T. Makhinova, D.T. Eurich, J.K. Minhas-Sandhu, J.A. Johnson, C. Necyk and M. Bhutani were responsible for the study concept and design. D.T. Eurich, J.K. Minhas-Sandhu and J.A. Johnson were responsible for the acquisition of data. All authors were responsible for the analysis and interpretation of data, as well as the critical revision of the manuscript. T. Makhinova, D.T. Eurich, J.A. Johnson, C. Necyk and M. Bhutani were responsible for obtaining the funding for the study.

Author note

Part of the results were accepted and presented at the 2021 Annual Canadian Association for Health Services and Policy Research (CAHSPR) Conference (May 19–21, 2021; Virtual).

Disclosure statement

M. Bhutani has consulted for Astra Zeneca, GlaxoSmithKline, Boehringer Ingelheim, Valeo, Covis and Sanofi. The authors declare no other relevant conflicts of interest or financial relationships.

Data availability statement

The dataset from this study is held securely in coded form at the School of Public Health, University of Alberta. Access may be granted to those who meet pre-specified criteria for confidential access.

Additional information

Funding

This study was supported by a grant from the M.S.I. Foundation [Grant#895] based in Alberta, Canada. The funder had no role in the design of the study, the collection, analysis and interpretation of the data.