Management of chronic airflow obstruction: differences in practice between respiratory and general physicians

Angus, R.M., Murray, S., Kay, J.W. , Thomson, N.C. and Patel, K.R. (1994) Management of chronic airflow obstruction: differences in practice between respiratory and general physicians. Respiratory Medicine, 88(7), 493 - 497. (doi: 10.1016/S0954-6111(05)80329-4) (PMID:7972971)

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An audit of inpatient care of diseases characterized by chronic airflow obstruction namely chronic bronchitis, emphysema and chronic obstructive airways disease (ICD Code Nos. 490–2 & 496) was performed and the practice of respiratory and general physicians compared. One hundred cases were sampled at random from 279 cases admitted to hospitals serving the West of Glasgow in 1988. Fifty cases were selected from those admitted under the care of respiratory physicians and 50 from those under general physicians; 89 were suitable for analysis. The main outcome measurements consisted of the use of routine respiratory investigations, comparison of the use of standard therapies during the admission and at discharge, length of stay, inpatient deaths, follow up and readmission rates. The groups were similar in age, smoking history, gender and there was no significant difference in admission arterial blood gas values. The pulse rate on admission was higher in the general group (102 beats per min) in comparison to the respiratory group (91 beats per min) (P<0·004). A similar use of chest radiograph and arterial blood gas analysis was noted between the groups. Ninety-six per cent of respiratory patients had either spirometry or peak expiratory flow measured compared to 62% in the general group (P=0·0001). No significant differences were noted in the use of antibiotics, bronchodilators, corticosteroids, oxygen or respiratory stimulants. The mean length of stay was similar. Two patients (4%) in the respiratory group compared with seven (18%) in the general group died during the admission (P=0·01); there were no further early deaths at 1 month from discharge. Follow up differed with 92% of respiratory patients being offered appointments compared with 62% in the general group (P=0·001). Readmission rates were similar and at 1 year 44% in both groups had been readmitted. In patients with a discharge diagnosis of chronic airflow obstruction respiratory physicians measure lung function more than general physicians and are more likely to review their patients. In this study a significantly higher inpatient death rate was noted amongst the group admitted under the care of the general physicians. The reason for this difference in death rate between the two groups is unclear.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Kay, Dr James
Authors: Angus, R.M., Murray, S., Kay, J.W., Thomson, N.C., and Patel, K.R.
College/School:College of Science and Engineering > School of Mathematics and Statistics > Statistics
Journal Name:Respiratory Medicine
Publisher:W.B. Saunders
ISSN (Online):1532-3064

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