Quality of care and clinical outcomes of chronic obstructive pulmonary disease in patients with schizophrenia. A Danish nationwide study.

Abstract

To examine the association between schizophrenia and the quality of care and clinical outcomes of chronic obstructive pulmonary disease (COPD). A Danish nationwide population-based cohort study using comprehensive information from Danish registries between 2008 and 2013. Public Danish hospitals. 72 692 COPD patients with hospital contacts including 621 with schizophrenia. COPD care. The quality of COPD care was defined as meeting guideline-recommended process performance measures of care. Potential predictors of COPD care among patients with schizophrenia included patient- (sex, age, alcohol or drug abuse, Global Assessment of Functioning score, duration of schizophrenia), provider- (quality of schizophrenia care), and system-related factors (contact-volume defined as hospital department and clinics' annual average contact volume of COPD patients). Clinical outcomes included 30-day all-cause readmission and 30-day all-cause mortality risk following an admission for exacerbation of COPD. Compared to COPD patients without schizophrenia, COPD patients with schizophrenia had a lower chance of receiving treatment with long-acting muscarinic antagonists (LAMA) or long-acting β2-agonists (LABA) (Relative risk (RR) 0.92, 95% CI: 0.87-0.98). Female sex was associated with a higher chance of receiving LAMA/LABA treatment among COPD patients with schizophrenia. COPD patients with schizophrenia had a higher risk of 30-day mortality (adjusted odds ratio (OR) 1.27, 95% CI: 1.01-1.59) but not a higher risk of readmission compared with COPD patients without schizophrenia. COPD patients with schizophrenia had a slightly lower chance of receiving LAMA/LABA treatment, but a substantially increased risk of death following admission for an exacerbation compared with patients without schizophrenia.