title: Resource use study in COPD (RUSIC): a prospective study to quantify the effects of COPD exacerbations on health care resource use among COPD patients.
abstract: BACKGROUND
  There is increasing interest in health care resource use (HRU) in Canada, particularly in resources associated with acute exacerbations of chronic obstructive pulmonary disease (COPD).
  
  
  OBJECTIVE
  To identify HRU due to exacerbations of COPD.
  
  
  METHODS
  A 52-week, multicentre, prospective, observational study of HRU due to exacerbations in patients with moderate to severe COPD was performed. Patients were recruited from primary care physicians and respirologists in urban and rural centres in Canada.
  
  
  RESULTS
  In total, 524 subjects (59% men) completed the study. Their mean age was 68.2+/-9.4 years, with a forced expiratory volume in 1 s of 1.01+/-0.4 L. Patients had significant comorbidities. There were 691 acute exacerbations of COPD, which occurred in 53% of patients: 119 patients (23%) experienced one acute exacerbation, 70 patients (13%) had two acute exacerbations and 89 patients (17%) had three or more acute exacerbations. Seventy-five patients were admitted to hospital, with an average length of stay of 13.2 days. Fourteen of the patients spent time in an intensive care unit (average length of stay 5.6 days). Factors associated with acute exacerbations of COPD included lower forced expiratory volume in 1 s (P<0.001), high number of respiratory medications prescribed (P=0.037), regular use of oral corticosteroids (OCSs) (P=0.008) and presence of depression (P<0.001). Of the 75 patients hospitalized, only 53 received OCSs, four received referral for rehabilitation and 15 were referred for home care.
  
  
  CONCLUSIONS
  The present study showed a high prevalence of COPD exacerbations, which likely impacted on HRU. There was evidence of a lack of appropriate management of exacerbations, especially with respect to use of OCSs, and referral for pulmonary rehabilitation and home care.
authors.affiliation: Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver. mark@interchange.ubc.ca
authors.forename: J Mark
authors.initials: JM
authors.lastname: FitzGerald
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Haddon
authors.forename: Carole
authors.initials: C
authors.lastname: Bradly-Kennedy
authors.forename: Lisa
authors.initials: L
authors.lastname: Kuramoto
authors.forename: Gordon T
authors.initials: GT
authors.lastname: Ford
mesh_terms: D000368:Aged; D002170:Canada / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D015995:Prevalence; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics* / Q000453:epidemiology; D040841:Resource Allocation; D019035:Rural Health Services / Q000706:statistics & numerical data*; D019037:Urban Health Services / Q000706:statistics & numerical data*