Chest
Volume 155, Issue 4, April 2019, Pages 771-777
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Original Research: COPD
Which Physicians Are Taking Care of People With COPD?

https://doi.org/10.1016/j.chest.2018.12.018Get rights and content

Background

There is limited knowledge on what proportions of patients with COPD receive ambulatory care from primary care physicians, pulmonologists, or other specialists. We evaluated the types and combinations of physicians who provide ambulatory care to patients with COPD.

Methods

We conducted a population-based cross-sectional study using health administrative datasets from Ontario, Canada between April 1, 2014 and March 31, 2015. Individuals age 35 years and older with physician-diagnosed COPD were identified, using a previously validated COPD case definition. The primary outcomes were ambulatory visits to primary care physicians, pulmonologists, and all other specialists within a 1-year period.

Results

There were 895,155 individuals identified as having physician-diagnosed COPD. Of those, 56,533 individuals (6.3%) had no ambulatory care visits, 802,327 (89.6%) saw primary care physicians, and 95,782 (10.7%) consulted pulmonologists. By comparison, 736,496 (82.3%) saw other specialists, and 218,997 (24.5%) saw cardiologists. There were 32,473 individuals (3.6%) who underwent COPD-related hospitalizations. Of those in the subcohort with one hospitalization, about 30.0% saw pulmonologists; 43.7% of those who underwent two or more hospitalizations saw pulmonologists, and 9.9% with no hospitalization consulted pulmonologists.

Conclusions

Primary care physicians play a substantial role in caring for patients with COPD. But only one-half as many patients with COPD saw pulmonologists than cardiologists, suggesting that COPD may receive less specialty care compared with other chronic medical conditions. This information can help inform COPD care strategies to improve COPD care and minimize exacerbations and associated health-care costs. It also suggests a need for more research to provide guidance on when patients with COPD should be referred to pulmonologists.

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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    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.

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