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.