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Concomitant pulmonologist and primary care for chronic obstructive pulmonary disease: a population study.
Gershon, Andrea S; Macdonald, Erin M; Luo, Jin; Austin, Peter C; Gupta, Samir; Sivjee, Khalil; Upshur, Ross; Aaron, Shawn D.
Afiliação
  • Gershon AS; Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
  • Macdonald EM; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
  • Luo J; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
  • Austin PC; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
  • Gupta S; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
  • Sivjee K; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
  • Upshur R; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
  • Aaron SD; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Fam Pract ; 34(6): 708-716, 2017 11 16.
Article em En | MEDLINE | ID: mdl-28985364
Background: Pulmonologists provide quality care, however, their number is not adequate to take care of all the chronic obstructive pulmonary disease (COPD) needs of the population and their services come with a cost. Their optimal role should be defined, ideally based on evidence, to ensure that their abilities are applied most efficiently where needed. Objective: To determine if concomitant pulmonologist and primary care physician care after COPD hospital or emergency department discharge was associated with better health outcomes than primary care services alone. Methods: A population cohort study was conducted in Ontario, Canada from 2004 to 2011. All individuals with a COPD hospital or emergency department discharge were included. Patients who visited both a pulmonologist and a primary care physician within 30 days of the index discharge were matched to patients who had visited a primary care physician alone using propensity scores. The composite outcome of death, COPD hospitalization or COPD emergency department visit was compared using proportional hazards regression. Results: In the propensity score matched sample, 39.7% of patients who received concomitant care and 38.9% who received primary care only died or visited the emergency department visit or hospital for COPD within 1 year (adjusted hazard ratio 1.08, 95% confidence interval 1.00-1.17). The former, however, were more likely to receive diagnostic testing and medications. Conclusion: Patients who received concomitant care after COPD emergency department or hospital discharge did not have better outcomes than those who received primary care alone, however, they did receive more testing and medical management.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Atenção Primária à Saúde / Doença Pulmonar Obstrutiva Crônica / Pneumologistas Tipo de estudo: Observational_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male País/Região como assunto: America do norte Idioma: En Revista: Fam Pract Ano de publicação: 2017 Tipo de documento: Article País de afiliação: Canadá

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Atenção Primária à Saúde / Doença Pulmonar Obstrutiva Crônica / Pneumologistas Tipo de estudo: Observational_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male País/Região como assunto: America do norte Idioma: En Revista: Fam Pract Ano de publicação: 2017 Tipo de documento: Article País de afiliação: Canadá