Readmissions for chronic obstructive pulmonary disease in actual clinical practice

Aim. Identification of risk factors for readmissions associated with exacerbation of chronic obstructive pulmonary disease followed by identification of possible quality defects in the provision of medical care to patients in the outpatient and hospital stages.

Methods. A retrospective analysis of the medical records of patients with exacerbation of chronic obstructive pulmonary disease admitted twice or more to the therapeutic department of one of the hospitals of Kazan during the period from January 1, 2015 to June 30, 2016.

Results. The risk factors for readmissions were found to be the following: male sex (relative risk 2.29; 95% CI 0.78-6.69; р ˂0.05), age over 70 years (relative risk 2.069; 95% CI 1.01-4.2; р ˂0.05), smoking for more than 40 years (relative risk 5.3; 95% CI 1.6-17.5; р ˂0.05), duration of the disease more than 6 years (relative risk 2.4; 95% CI 0.98-6.18; р ˂0.05), presence of three or more concomitant diseases, primarily cardiovascular pathology (relative risk 13.0; 95% CI 1.89-90.14; р ˂0.05). Important reasons for subsequent exacerbations after discharge from the hospital are patients' nonadherence and defects of the provision of medical care in the hospital.

Conclusion. The revealed defects of the quality of medical care indicate the need to intensify the implementation of the federal clinical guidelines for chronic obstructive pulmonary disease in actual medical practice; due to the difficulty of modifying the identified risk factors, the main efforts should be directed at treatment optimization with adherence control, as well as full use of the potential for non-drug treatment in the form of guidelines for maintaining physical activity, early smoking quitting and patients' rehabilitation.