Programme no. 246-OP
Public Health
General practitioners’ home visit tendency and readmissionfree survival after COPD hospitalisation: a Danish nationwide cohort study
Jesper Lykkegaard*1, Maja Skov Paulsen2, Pia Veldt Larsen3, Jens Søndergaard4
1Department of Public Health, Research Unit of General Practice,University of Southern Denmark, Faculty of Health Sciences,DK-5000 Odense C,Denmark, 2Department of Public Health, Research Unit of General Practice,University of Southern Denmark, Faculty of Health Sciences,DK-5000 Odense C,Denmark, 3Department of Public Health, Research Unit of General Practice,University of Southern Denmark, Faculty of Health Sciences,DK-5000 Odense C,Denmark, 4Department of Public Health, Research Unit of General Practice,University of Southern Denmark, Faculty of Health Sciences,DK-5000 Odense C,Denmark
* = Presenting author
Objectives: To investigate whether GPs’ tendency to conduct home visits affects 30-day readmission or death after hospitalisation with chronic obstructive pulmonary disease.
Background: The tendency of general practitioners (GPs) to conduct home visits is considered an important aspect of practices’ accessibility and quality of care.
Results: The study included 14,425 patients listed with 1,389 general practices. Approximately 31% of the patients received a home visit during the year preceding their first COPD hospitalisation, and within 30 days after discharge 19% had been readmitted and 1.6% had died without readmission. A U-shaped dose–response relationship was found between GP home visit tendency and readmission-free survival. The lowest adjusted risk of readmission or death was recorded among patients who were listed with a
general practice in which >20–30% of other listed first-time COPD-hospitalised patients had received a home visit. The risk was higher if either 0% (hazard rate ratio 1.18 (1.01–1.37)) or 460% (hazard rate ratio 1.23 (1.04–1.44)) of the patients had been visited.
Material/Methods: All Danish patients first-time hospitalised with COPD during the years 2006–2008 were identified. The association between the GP’s tendency to conduct home visits and the time from hospital discharge until death or all-cause readmission was analysed by means of Cox regression adjusted for multiple patient and practice characteristics.
Conclusion: A moderate GP tendency to conduct home visits is associated with the lowest 30-day risk of COPD readmission or death. A GP’s tendency to conduct home visits should not be used as a unidirectional indicator of the ability to prevent COPD hospital readmissions.
Points for discussion: For elderly patients, easy access to GP home visits has been believed to prevent unnecessary hospitalisations. This study indicates that the opposite may more often be the case.