TY - JOUR
T1 - Quality of care and clinical outcomes of chronic obstructive pulmonary disease in patients with schizophrenia
T2 - A Danish nationwide study
AU - Jørgensen, Mette
AU - Mainz, Jan
AU - Lange, Peter
AU - Paaske Johnsen, Søren
N1 - 10.1093/intqhc/mzy014
PY - 2018
Y1 - 2018
N2 - Objective: To examine the association between schizophrenia and the quality of care and clinical outcomes of chronic obstructive pulmonary disease (COPD). Design: A Danish nationwide population-based cohort study using comprehensive information from Danish registries between 2008 and 2013. Setting: Public Danish hospitals. Participants: 72 692 COPD patients with hospital contacts including 621 with schizophrenia. Intervention: COPD care. Main Outcome Measures: The quality of COPD care was defined as meeting guideline-recommended process performance measures of care. Potential predictors of COPD care among patients with schizophrenia included patient- (sex, age, alcohol or drug abuse, Global Assessment of Functioning score, duration of schizophrenia), provider- (quality of schizophrenia care), and system-related factors (contact-volume defined as hospital department and clinics' annual average contact volume of COPD patients). Clinical outcomes included 30-day all-cause readmission and 30-day all-cause mortality risk following an admission for exacerbation of COPD. Results: Compared to COPD patients without schizophrenia, COPD patients with schizophrenia had a lower chance of receiving treatment with long-acting muscarinic antagonists (LAMA) or long-acting ß2-agonists (LABA) (Relative risk (RR) 0.92, 95% CI: 0.87-0.98). Female sex was associated with a higher chance of receiving LAMA/LABA treatment among COPD patients with schizophrenia. COPD patients with schizophrenia had a higher risk of 30-day mortality (adjusted odds ratio (OR) 1.27, 95% CI: 1.01-1.59) but not a higher risk of readmission compared with COPD patients without schizophrenia. Conclusions: COPD patients with schizophrenia had a slightly lower chance of receiving LAMA/ LABA treatment, but a substantially increased risk of death following admission for an exacerbation compared with patients without schizophrenia.
AB - Objective: To examine the association between schizophrenia and the quality of care and clinical outcomes of chronic obstructive pulmonary disease (COPD). Design: A Danish nationwide population-based cohort study using comprehensive information from Danish registries between 2008 and 2013. Setting: Public Danish hospitals. Participants: 72 692 COPD patients with hospital contacts including 621 with schizophrenia. Intervention: COPD care. Main Outcome Measures: The quality of COPD care was defined as meeting guideline-recommended process performance measures of care. Potential predictors of COPD care among patients with schizophrenia included patient- (sex, age, alcohol or drug abuse, Global Assessment of Functioning score, duration of schizophrenia), provider- (quality of schizophrenia care), and system-related factors (contact-volume defined as hospital department and clinics' annual average contact volume of COPD patients). Clinical outcomes included 30-day all-cause readmission and 30-day all-cause mortality risk following an admission for exacerbation of COPD. Results: Compared to COPD patients without schizophrenia, COPD patients with schizophrenia had a lower chance of receiving treatment with long-acting muscarinic antagonists (LAMA) or long-acting ß2-agonists (LABA) (Relative risk (RR) 0.92, 95% CI: 0.87-0.98). Female sex was associated with a higher chance of receiving LAMA/LABA treatment among COPD patients with schizophrenia. COPD patients with schizophrenia had a higher risk of 30-day mortality (adjusted odds ratio (OR) 1.27, 95% CI: 1.01-1.59) but not a higher risk of readmission compared with COPD patients without schizophrenia. Conclusions: COPD patients with schizophrenia had a slightly lower chance of receiving LAMA/ LABA treatment, but a substantially increased risk of death following admission for an exacerbation compared with patients without schizophrenia.
KW - Chronic obstructive
KW - Health care disparities
KW - Pulmonary disease
KW - Quality of health care
KW - Schizophrenia
UR - http://www.scopus.com/inward/record.url?scp=85051567149&partnerID=8YFLogxK
U2 - 10.1093/intqhc/mzy014
DO - 10.1093/intqhc/mzy014
M3 - Journal article
SN - 1353-4505
VL - 30
SP - 351
EP - 357
JO - International Journal for Quality in Health Care
JF - International Journal for Quality in Health Care
IS - 5
ER -