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COPD ambulatory care by pulmonologists low in Canadian study

Only 1 in 10 patients with chronic obstructive pulmonary disease visited a pulmonologist within a 1-year period in Ontario, Canada, according to recent data published in Chest.

Using health administrative data sets from Ontario from April 2014 to March 2015, researchers identified 895,155 patients aged 35 years and older with physician-diagnosed COPD. About half of the cohort were men, 52.6% were aged at least 65 years and 84% lived in urban areas.

Six percent of patients with COPD had no outpatient physician visits, 89.6% saw primary care physicians, 10.7% consulted pulmonologists and 82.3% visited nonpulmonary specialists combined with other physician types.

Most patients (78.9%) saw two or more different types of these physicians, including 10.1% who saw all three types of physicians, and 14.8% only saw one type of physician.

Notably, 24.5% of patients consulted a cardiologist, the researchers noted. When substituting cardiologists for pulmonologists, they found that the percentage of patients who saw noncardiac specialists was lower than the percentage of patients who saw nonpulmonary specialists in the main analysis (69.2% vs. 83%).

Patients who were hospitalized for COPD were more likely to see a pulmonologist, the researchers reported. Whereas 9.9% of patients with no hospitalizations visited a pulmonologist, 30% of those with one hospitalization and 43.7% of those with at least two hospitalizations visited pulmonologists.

The proportion of patients who saw pulmonologists was also higher among those aged at least 65 years vs. younger than 65 years (13.1% vs. 8.1%) and those living in urban vs. rural regions (11.42% vs. 6.86%). Visits to all three types of physicians, including pulmonologists, increased with increasing income.

As part of a sensitivity analysis, the researchers extended the observation period to 2 years, where there was a slight increase in ambulatory visits to all three types of physicians. However, the proportions remained similar to the 1-year analysis, with patients seeing pulmonologists the least frequently.

Importantly, this study was based only on data from Ontario and, thus, “the generalizability of [the] findings might be limited,” the researchers noted. Another limitation of the overall findings, according to the researchers, is “given that physicians tend to underdiagnose COPD, [the] COPD cohort probably missed a number of individuals with COPD who could have benefited from pulmonologist care.” The study also looked at only ambulatory visits and excluded emergency and inpatient consults.

“There is a great opportunity to optimize ambulatory care for people with COPD, improving their health outcomes and decreasing health-care costs by increasing involvement of pulmonologists in COPD treatment,” the researchers wrote. “Future studies should establish evidence-based criteria for when patients with COPD should be referred to pulmonologists.” – by Melissa Foster

Disclosures: The study was funded through a Health Systems Research Fund Capacity Grant from the Province of Ontario and was also supported by the Institute for Clinical Evaluative Sciences. One author reports she has received grants from the Ontario Ministry of Health and Long-Term Care. All other authors report no relevant financial disclosures.