Emergency department return visits in chronic obstructive pulmonary disease: the importance of psychosocial factors.
OBJECTIVE
Relapses are common after treatment of decompensated chronic obstructive pulmonary disease (COPD) in the emergency department. The purpose of this study was to identify psychosocial and pulmonary function variables that distinguish patients who relapse from those who do not.


METHODS
Retrospective case analysis. A relapse was defined as an unscheduled return to the ED within two weeks of treatment.


METHODS
475-bed Veterans Administration Medical Center.


METHODS
33 male veterans with COPD who used the ED.


METHODS
Demographic profile, a Likert-scaled questionnaire about illness beliefs, and physiologic data obtained by chart review.


RESULTS
Patients who relapsed at least once (R patients) were more likely to be widowed, separated, or divorced than patients who did not relapse at any time (N patients) (52.4% vs 8.3%; P = .011). R patients were more likely to have lost a first-order relative within three years (57.1% vs 8.3% P = .006). Stepwise logistic regression showed that the loss of a first-order relative, a negative attitude about prognosis, and a higher forced vital capacity distinguished R from N patients. Stepwise linear regression showed that six specific illness beliefs, distance of the home from the hospital, and baseline bronchodilator response correlated with the number of relapses (multiple r2 = 0.82; P less than .001).


CONCLUSIONS
Social and psychological parameters are closely correlated with relapse in patients with decompensated COPD.
Ambulatory Care Service, Veterans Affairs Medical Center, Albuquerque, New Mexico 87108.
D E
DE
Stehr
B J
BJ
Klein
G H
GH
Murata
D000368:Aged; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009516:New Mexico; D011610:Psychosocial Deprivation; D012008:Recurrence; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D011795:Surveys and Questionnaires