Obstructive Lung Diseases: Airways 5 |

Profile of Frequent ED Users Among Patients Diagnosed With Chronic Obstructive Lung Disease FREE TO VIEW

Penny Wagner, FNP-BC; Mohammed Zaidan, MD; Shawn Nishi, MD; Alexander Duarte, MD
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University of Texas Medical Branch, Galveston, TX

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):874A. doi:10.1016/j.chest.2016.08.974
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SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: In patients with chronic obstructive pulmonary disease (COPD), frequent utilization of emergency department (ED) services may allow identification of factors associated with suboptimal care. Furthermore, patients with COPD treated in the ED may be more likely to be hospitalized and thereby increase their cost of care. Identification of the characteristics of patients that utilize the ED frequently may lead to improved care strategy. Our goal was to identify patients with COPD treated in an ambulatory setting who utilize the ED more than two times in a 12 month period and determine the patient factors that lead to frequent ED visits.

METHODS: We identified patients seen in an outpatient pulmonary clinic with COPD who had two or more ED visits in the prior 12 month period. Patient electronic medical records were reviewed and the following data collected: demographics, insurance status, tobacco use, medications, comorbidities and ED visits. Results are presented as proportions and percentages.

RESULTS: From 8/2014 to 7/2015, 388 patients were cared for in the pulmonary clinic and 38/388 (9.8 %) utilized the ED two or more times. The characteristics of the frequent utilizers revealed a mean age of 68.3 ± 14.4 with a female predominance (58 %) and majority were Caucasian (68 %). Mean FEV1 was 1.40 ± 0.63 L. Twenty nine patients (76 %) were noted to be living with a spouse or family. Insurance status included Medicare (53%), Medicaid (18 %) and dual eligible (11 %). Former smokers were noted in 74 % of the group. Cardiovascular conditions included heart failure with preserved ejection fraction (76 %), heart failure with reduced ejection fraction (24 %) and hypertension (71 %). Sleep disordered breathing was recognized in 29%. Psychiatric disorders including bipolar disorder, schizophrenia and anxiety was noted in 40% of the cohort. Long term oxygen therapy was prescribed to 53 % of patients. The majority were prescribed a short and long acting beta agonist (Table 1). ED visits related to COPD were noted in 24 patients (63 %) with long term oxygen treatment prescribed to 16/24 (67 %). In patients with a COPD related ED visit, heart failure with preserved ejection fraction was observed in 92 % and sleep disordered breathing in 38 %.

CONCLUSIONS: Patients with COPD that utilize the ED two or more times in a 12 month period were noted to have moderate airflow limitation and frequent comorbidities included cardiovascular and psychiatric disorders. In patients with an ED visit related to COPD, heart failure with preserved ejection fraction was observed in the majority.

CLINICAL IMPLICATIONS: In patients diagnosed with COPD, cardiovascular and psychological disorders play a role in high utilization of emergency department.

DISCLOSURE: The following authors have nothing to disclose: Penny Wagner, Mohammed Zaidan, Shawn Nishi, Alexander Duarte

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