BACKGROUND: Exacerbations in chronic respiratory diseases (CRDs) are sensitive to seasonal variations in exposure to respiratory infectious agents and allergens and patient factors such as non-adherence. Hence, regular general practitioner (GP) contact is likely to be important in order to recognise symptom escalation early and adjust treatment. OBJECTIVE: To examine the association of regularity of GP visits with all-cause mortality and first CRD hospitalisation overall and within groups of pharmacotherapy level in older CRD patients. DESIGN: A retrospective cohort design using linked hospital, mortality, Medicare and pharmaceutical data for participant, exposure and outcome ascertainment. GP visit pattern was measured during the first 3 years of the observation period. Patients were then followed for a maximum of 11.5 years for ascertainment of hospitalisations and deaths. PARTICIPANTS: We studied 108,455 patients aged >or=65 years with CRD in Western Australia (WA) during 1992-2006. MAIN MEASURES: A GP visit regularity score (range 0-1) was calculated and divided into quintiles. A clinician consensus panel classified levels of pharmacotherapy. Cox proportional hazards models, controlling for multiple factors including GP visit frequency, were used to calculate hazard ratios and confidence intervals. KEY RESULTS: Differences in survival curves and hospital avoidance pattern between the GP visit regularity quintiles were statistically significant (p = 0.0279 and p < 0.0001, respectively). The protective association between GP visit regularity and death appeared to be confined to the highest pharmacotherapy level group (P for interaction = 0.0001). Higher GP visit regularity protected against first CRD hospitalisation compared with the least regular quintile regardless of pharmacotherapy level (medium regular: HR = 0.84, 95% CI = 0.77-0.92; 2nd most regular: HR = 0.74, 95% CI = 0.67-0.82; most regular HR = 0.77, 95% CI = 0.68-0.86). CONCLUSIONS: The findings indicate that regular and proactive 'maintenance' primary care, as distinct from 'reactive' care, is beneficial to older CRD patients by reducing their risks of hospitalisation and death.
BACKGROUND: Exacerbations in chronic respiratory diseases (CRDs) are sensitive to seasonal variations in exposure to respiratory infectious agents and allergens and patient factors such as non-adherence. Hence, regular general practitioner (GP) contact is likely to be important in order to recognise symptom escalation early and adjust treatment. OBJECTIVE: To examine the association of regularity of GP visits with all-cause mortality and first CRD hospitalisation overall and within groups of pharmacotherapy level in older CRDpatients. DESIGN: A retrospective cohort design using linked hospital, mortality, Medicare and pharmaceutical data for participant, exposure and outcome ascertainment. GP visit pattern was measured during the first 3 years of the observation period. Patients were then followed for a maximum of 11.5 years for ascertainment of hospitalisations and deaths. PARTICIPANTS: We studied 108,455 patients aged >or=65 years with CRD in Western Australia (WA) during 1992-2006. MAIN MEASURES: A GP visit regularity score (range 0-1) was calculated and divided into quintiles. A clinician consensus panel classified levels of pharmacotherapy. Cox proportional hazards models, controlling for multiple factors including GP visit frequency, were used to calculate hazard ratios and confidence intervals. KEY RESULTS: Differences in survival curves and hospital avoidance pattern between the GP visit regularity quintiles were statistically significant (p = 0.0279 and p < 0.0001, respectively). The protective association between GP visit regularity and death appeared to be confined to the highest pharmacotherapy level group (P for interaction = 0.0001). Higher GP visit regularity protected against first CRD hospitalisation compared with the least regular quintile regardless of pharmacotherapy level (medium regular: HR = 0.84, 95% CI = 0.77-0.92; 2nd most regular: HR = 0.74, 95% CI = 0.67-0.82; most regular HR = 0.77, 95% CI = 0.68-0.86). CONCLUSIONS: The findings indicate that regular and proactive 'maintenance' primary care, as distinct from 'reactive' care, is beneficial to older CRDpatients by reducing their risks of hospitalisation and death.
Authors: J Sunyer; J M Antó; D McFarlane; A Domingo; A Tobías; M A Barceló; A Múnoz Journal: Am J Respir Crit Care Med Date: 1998-09 Impact factor: 21.405
Authors: A B Bindman; K Grumbach; D Osmond; M Komaromy; K Vranizan; N Lurie; J Billings; A Stewart Journal: JAMA Date: 1995-07-26 Impact factor: 56.272
Authors: Dianne P Goeman; Rosalie A Aroni; Susan M Sawyer; Kay Stewart; Francis C K Thien; Michael J Abramson; Jo A Douglass Journal: Med J Aust Date: 2004-02-02 Impact factor: 7.738
Authors: Paul E Ronksley; Pietro Ravani; Claudia Sanmartin; Hude Quan; Braden Manns; Marcello Tonelli; Brenda R Hemmelgarn Journal: BMC Health Serv Res Date: 2013-10-09 Impact factor: 2.655