title: Does place of treatment affect prognosis for chronic obstructive pulmonary disease (COPD)?
abstract: BACKGROUND
  It has been shown previously that mortality from acute chronic obstructive pulmonary disease (COPD) is higher at small hospitals than at large teaching hospitals.
  
  
  OBJECTIVE
  To examine mortality at this acute stage and referral for further treatment by specialities in Finland, and trends in these between the 1990s and 2000s.
  
  
  METHODS
  Data on all periods of treatment for patients over 44 years of age with a principal or subsidiary diagnosis of COPD beginning and ending in 1995-2004 were extracted from the Finnish hospital discharge register. Particular attention was paid to acute-stage treatment periods managed by a general practitioner, pulmonary specialist, or specialist in internal medicine that had begun as emergency admissions and had a principal diagnosis of COPD, and to any further treatment immediately following these.
  
  
  RESULTS
  General practitioners referred 5.1% of their acute-stage patients to a specialist in secondary care in 1995-2004. Of the total of 77,445 acute-stage treatment periods, 3% (2328) ended in the death of the patient, implying the loss of 8.3% of the patients involved. The age- and sex-adjusted risk of death attached to treatment periods managed by a general practitioner relative to those managed by a pulmonary specialist was 0.83 (95% CI 0.75-0.91).
  
  
  CONCLUSIONS
  It is quite possible to treat acute exacerbations of COPD efficiently and safely in a health centre hospital ward. New treatment modalities and health service structures seem to have led to a decrease in acute exacerbations of COPD since the year 2000, even though the number of patients with this disease has increased as a consequence of ageing of the population. Further research is required on the efficacy of treatment by a general practitioner, e.g., with data on re-hospitalization.
authors.affiliation: Department of Public Health Science and General Practice, University of Oulu, Oulu, Finland. pekka.lampela@pp.inet.fi
authors.forename: Pekka
authors.initials: P
authors.lastname: Lampela
authors.forename: Olli
authors.initials: O
authors.lastname: Säynäjäkangas
authors.forename: Jari
authors.initials: J
authors.lastname: Jokelainen
authors.forename: Timo
authors.initials: T
authors.lastname: Keistinen
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005387:Finland / Q000453:epidemiology; D058005:General Practitioners / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality / Q000628:therapy*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012042:Registries; D063127:Secondary Health Care / Q000379:methods / Q000706:statistics & numerical data*; D013038:Specialization / Q000706:statistics & numerical data*