Patterns and determinants of COPD-related healthcare utilization by severity of airway obstruction in Korea

BMC Pulmonary Medicine

Youngsam Kim²  Jinhee Kim⁴  Sekyu Kim²  Yeonmok Oh³  Kyungwon Oh¹  Jiye Jung²  Kyungjoo Kim⁵  Kyungsoo Chung² 

[1] Division of Health and Nutrition Survey, Korea Centers for Disease Control and Prevention, Osong, Chungcheongbuk-do, Republic of Korea;Division of Pulmonology, Department of Internal Medicine, The Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea;Department of Pulmonary and Critical Care Medicine, and Asthma Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea;Department of Nursing, College of Medicine, Chosun University, Gwangju, Republic of Korea;Yuhan Research Institute, Yongin, Gyeonggi-do, Republic of Korea

关键词: National health insurance claims;    Korean National Health and Nutritional Examination Survey;    Healthcare use;    Chronic obstructive lung disease;   

Others  :  1109602
DOI  :  10.1186/1471-2466-14-27

 received in 2013-03-08, accepted in 2014-02-19,  发布年份 2014

【 摘 要 】

Background

We investigated patients with chronic obstructive pulmonary disease (COPD) to analyze patterns and identify determinants of healthcare use, according to the severity of airflow obstruction. We used retrospective cohort data from a combination of the 4^th Korea National Health and Nutritional Examination Survey (KNHANES) and Korean National Health Insurance (NHI) claims.

Methods

Demographic and medical claims data were retrospectively analyzed from the 4^th KNHANES along with NHI claims. Eligible patients were aged ≥40 years, who underwent complete pulmonary function tests (PFTs), and had at least one inpatient or outpatient claim coded as COPD between January 1, 2007 and December 31, 2010.

Results

Among 6,663 eligible participants, 897 (13.5%) had airway obstruction. Self-reported physician-diagnosed COPD comprised only 3%, and there were 870 undiagnosed COPD patients (97%). Self-reported physician-diagnosed asthma made up 3.7%. Of the 897 respondents, 244 (27.2%) used COPD-related healthcare services. The frequency of healthcare visits increased with increasing severity of airway obstruction. After a 3-year follow-up period, 646 (74.2% of those initially undiagnosed) remained undiagnosed and only 224 (25.8%) were diagnosed and treated for COPD. Only 27.5% of the 244 participants with airway obstruction who used COPD-related healthcare underwent PFTs during the study period. The percentage of prescribed medications associated with COPD increased in accordance with the severity of the COPD. Inhaled long-acting anticholinergics were prescribed for 10.9% of patients with moderate airway obstruction and for 52.4% of patients with severe obstruction. Inhaled long-acting β-agonists combined with corticosteroids were prescribed for 50% of patients with severe airway obstruction. Conversely, 44.6% of healthcare users were prescribed oral theophylline for COPD treatment, and 21.7% were also prescribed an oral corticosteroid. The determinants of COPD-associated healthcare use in respondents with obstructive lung disease were advanced age, severe airflow limitation, presence of comorbidities, and self-reported physician diagnosis of COPD.

Conclusions

This study ascertained marked underdiagnosed COPD. Although the percentage of prescribed medication used to treat COPD increased with the severity of the COPD, medications primarily prescribed such as oral theophylline or oral corticosteroids are inappropriate for first-line COPD treatment.

【 授权许可】

   
2014 Chung et al.; licensee BioMed Central Ltd.

【 图 表 】

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