Chest
Original Research: COPDWhich Physicians Are Taking Care of People With COPD?
Section snippets
Study Design and Setting
We conducted a descriptive population-based, cross-sectional study using health administrative data from Ontario, Canada. Ontario is the largest province in Canada, and virtually all its multiethnic population of approximately 13.7 million receive health care funded by provincially run health-care insurance. Our primary objective was to determine what proportion of patients with COPD received ambulatory care from PCPs, pulmonologists, and all nonpulmonary specialists combined. As a secondary
Results
There were 895,155 individuals with physician-diagnosed COPD living in Ontario, Canada on April 1, 2015. About 49.4% were men, 52.6% were 65 years old or older, and 84% were from urban areas. During the 1-year look-back period, most visited at least one type of physician, while 6.3% had no outpatient physician visits at all.
Overall, 89.6% of patients with COPD saw primary care physicians, 10.7% saw pulmonologists, and 82.3% saw nonpulmonary specialists in varying combinations with other
Discussion
We conducted a population study of people in Ontario with physician-diagnosed COPD to determine the proportions who received care from primary care physicians, pulmonologists, and nonpulmonary specialists combined in a 1-year period and found that only about 10% of people visited pulmonologists, while a substantial majority saw PCPs and other specialists. The proportion seeing pulmonologists was less than one-half the proportion of the same group who saw cardiologists. There was a significant
Acknowledgments
Author contributions: A. S. G. and G. C. M. had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. A. S. G. and E. E. C. conceived the study. A. S. G. acquired the health administrative data. All authors designed the study and interpreted the data. G. C. M. carried out the statistical analysis. A. S. G. and E. E. C. drafted the manuscript. All authors critically revised the manuscript for important intellectual
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2020, International Journal of Medical InformaticsCitation Excerpt :COPD is a leading cause of morbidity and mortality [13] and is often present with other chronic conditions [12]. In Canada, COPD is mostly managed in primary care [14] and was the second leading cause of hospitalization in Canada after childbirth in 2017/18 [15], accounting for an estimated cost of $1.5 billion annually [16]. COPD is an ambulatory care sensitive condition, where appropriate management in primary care may prevent exacerbation-related hospitalizations [17].
Redesigning Care for OSA
2020, ChestCitation Excerpt :One key limitation in providing OSA care is the lack of sleep specialists.6 Common conditions such as COPD and depression face similar disparities between prevalence of disease and specialist availability,70,71 and primary care manages these conditions in most patients.72,73 Research illustrates the possible role of primary care providers and other nonspecialists in expanding access.
FUNDING/SUPPORT: Funding for this project was made available through a Health Systems Research Fund Capacity Grant from the Province of Ontario. This study was also supported by the ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). A. S. G. is supported by a Canadian Institutes of Health Research New Investigator Award and was supported by a Fellowship for Translational Health Research from the Physicians’ Services Incorporated Foundation, Toronto, ON, while working on this study.