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Effect of the economic crisis on the use of health and home care services among Spanish COPD patients

Authors de Miguel-Diez J, Lopez-de-Andres A, Hernandez-Barrera V, Jimenez-Trujillo I, Puente-Maestu L, Cerezo-Lajas A, Jimenez-Garcia R

Received 29 August 2017

Accepted for publication 28 December 2017

Published 28 February 2018 Volume 2018:13 Pages 725—739

DOI https://doi.org/10.2147/COPD.S150308

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Charles Downs

Peer reviewer comments 2

Editor who approved publication: Dr Richard Russell


Javier de Miguel-Diez,1 Ana Lopez-de-Andres,2 Valentin Herandez-Barrera,2 Isabel Jimenez-Trujillo,2 Luis Puente-Maestu,1 Alicia Cerezo-Lajas,1 Rodrigo Jimenez-Garcia2

1Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; 2Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain

Background:
Chronic obstructive pulmonary disease (COPD) is a major cause of disability and death worldwide. Consequently, COPD patients are frequent users of health and social resources. Therefore, they are highly vulnerable to decreases in investment in healthcare services. We aimed to describe the utilization of health and home care services among Spanish COPD patients during the economic crisis to identify factors independently associated with changes in the utilization of these services and to study the time trends from 2009 to 2014.
Methods: We used data from the European Health Interview Surveys for Spain (EHSS) conducted between 2009/2010 (n=22,188) and 2014 (n=22,842). We included responses from adults with COPD aged 40 years or over. Dependent variables included self-reported hospitalizations during the previous year, general practitioner (GP) visits during the last 4 weeks, other health care services used during the previous year (nursing, rehabilitation, and psychological services), and home care services use during the previous year. Independent variables included demographic and socioeconomic characteristics, health status variables, and lifestyles.
Results: We identified 1,328 and 1,008 COPD patients from EHSS 2009 and EHSS 2014, respectively. We observed a significant increase in non-GP services use (30.6% in 2009 vs 39.11% in 2014; p<0.001). No changes were found for hospitalizations, GP visits, and home care services use over time. Multivariable models showed that associated factors with a higher use included any chronic comorbidity and worse self-rated health. Physical activity was a strong predictor of fewer hospitalizations and less home care service use. Female sex was associated with significantly fewer hospitalizations (OR 0.72; 95% CI 0.58–0.89).
Conclusion: We found an increase in the use of non-GP services (nursing, rehabilitation, and psychological) but not in other health and home care services. The only differences in hospitalizations were observed according to sex. Therefore, the effect of the economic crisis, if any, seems to have been of small magnitude.

Keywords: COPD, healthcare services, population-based, time trends, survey, economic crisis

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