Effecten van gestructureerde COPD-zorg vanuit zorginkoopperspectief

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Van Dijk P, Van der Galiën O, Poll A. Effect of structured care for COPD patients from a health insurance perspective. Huisarts Wet 2010;53(9):464-7. Introduction We investigated whether coordinated and structured care provided by general practitioners for patients with chronic obstructive pulmonary disease (COPD) leads to better disease management and improved patient outcomes, namely, fewer exacerbations and a better quality of life. Method Patients insured with the Agis Health Insurance Company who were older than 40 years and not taking drugs for respiratory diseases or cardiovascular diseases at the time of inclusion participated in this study. They were on the lists of three groups of general practitioners in Amsterdam: GPs who offered structured care, including a GP specialized in COPD (intervention group), GPs in the same area, and GPs in other areas of Amsterdam (control groups). Patients who started using drugs for respiratory diseases were followed up for 5 years, to determine whether the groups were similar in terms of number of new users and duration of medicine use. In year 5, we assessed the relative risk of hospital admission for COPD, and the use of high-dose prednisone therapy and antibiotics. Results The cohort consisted of 105,942 individuals. The proportion of new users of respiratory drugs and the duration of medicine use were similar in the three groups. The risk of hospitalization was nearly 2.5-times higher and the use of high-dose prednisone therapy and antibiotics was 1.3-times higher in the control groups than in the intervention group. Conclusion Structured care for COPD patients would appear to lead to better clinical outcomes. Health insurance companies should encourage this type of care for these patients.