Health care utilization among chronic obstructive pulmonary disease patients and the effect of pulmonary rehabilitation

ABSTRACT

The present study aimed to analyze the utilization of health care resources among patients with chronic obstructive pulmonary disease [COPD] and to evaluate the effect of adherence to a pulmonary rehabilitation [PR] program on the utilization of these resources. A retrospective review of medical charts of a group of patients with COPD who were enrolled in a standard outpatient PR program at a tertiary care teaching hospital was conducted. Eligible patients were above the age of 18 years with a history of dyspnea, chronic cough and/or exposure to a disease risk factor with a postbronchodilator FEV1/FVC ratio <0.7. Fifty patients were referred to the PR program. The average number of emergency department visits was 1.4 +/- 1.6 days, the length of stay in the hospital was 1.7 +/- 3.8 days, the pulmonary clinic scheduled visits were 3.9 +/- 2.2, the use of combined inhalers was 9.0 +/- 3.9 canisters, the use of short-acting bronchodilator was 9.0 +/- 5.6 canisters, the cumulative prednisone doses were 427.5 +/- 463 mg, and the use of antibiotic courses was 3.1 +/- 2.9. Of the referred patients, 27 [54%] were adherent and 23 [46%] were not. Except for the use of combined inhalers, all parameters were significantly reduced in the adherent group. In contrast, the nonadherent group had increases in use of prednisone and antibiotics [p < 0.05]. There was a reduction in the utilization of health care resources among adherent patients with COPD who completed a PR program as reflected in selected pharmacological and nonpharmacological parameters