Potential barriers to physician follow-up within 7 days of discharge from a chronic obstructive pulmonary disease hospital admission

Abstract

RATIONALE: Given that physician follow-up after hospital may reduce readmissions for patients with chronic obstructive pulmonary disease (COPD), understanding factors associated with follow-up could help to improve discharge transitions. OBJECTIVES: To determine rate and factors associated with physician follow-up within 7 days of discharge from a COPD-related hospitalization. METHODS: Population-based retrospective cohort study of patients with COPD discharged from an Ontario hospital between April 1, 2010 and March 31, 2016 using health administrative data. All patients > =35 years old were included. The primary outcome was follow-up with family doctor, respirologist or internal medicine specialist within 7 days of discharge. Multivariable logistic regression analysis was used to determine demographic, socioeconomic, provider and health care access variables associated with follow-up. MEASUREMENTS AND MAIN RESULTS: Overall, 24,438 (29.8%) out of 81,960 patients had physician follow-up within 7 days of discharge. Women (OR 0.89, 95% CI 0.86-0.91), rural dwellers (OR 0.86, 95% CI 0.82-0.90), patients without a family doctor (OR 0.38, 95% CI 0.34-0.44) and those from low-income regions, or those who had hospital length-of-stay >7 days (OR 0.81, 95% CI 0.78-0.85) were less likely to receive follow-up within 7 days. Patients were more likely to receive follow-up if they required intensive care (OR 1.07, 95% CI 1.02-1.12) or had seen a physician frequently in the past. CONCLUSIONS: Fewer than 1 in 3 patients received early follow-up. Barriers to follow-up may exist for women, rural-dwellers, patients without a family doctor, those residing in low-income regions, or who experienced prolonged hospital stays.