Effect of the economic crisis on the use of health and home care services among Spanish COPD patients

Abstract

Background

Chronic obstructive pulmonary disease (COPD) is a major cause of disability and death worldwide. Consequently, COPD patients are frequent users of health and social resources. Therefore, they are highly vulnerable to decreases in investment in healthcare services. We aimed to describe the utilization of health and home care services among Spanish COPD patients during the economic crisis to identify factors independently associated with changes in the utilization of these services and to study the time trends from 2009 to 2014.

Methods

We used data from the European Health Interview Surveys for Spain (EHSS) conducted between 2009/2010 (n=22,188) and 2014 (n=22,842). We included responses from adults with COPD aged 40 years or over. Dependent variables included self-reported hospitalizations during the previous year, general practitioner (GP) visits during the last 4 weeks, other health care services used during the previous year (nursing, rehabilitation, and psychological services), and home care services use during the previous year. Independent variables included demographic and socioeconomic characteristics, health status variables, and lifestyles.

Results

We identified 1,328 and 1,008 COPD patients from EHSS 2009 and EHSS 2014, respectively. We observed a significant increase in non-GP services use (30.6% in 2009 vs 39.11% in 2014; p<0.001). No changes were found for hospitalizations, GP visits, and home care services use over time. Multivariable models showed that associated factors with a higher use included any chronic comorbidity and worse self-rated health. Physical activity was a strong predictor of fewer hospitalizations and less home care service use. Female sex was associated with significantly fewer hospitalizations (OR 0.72; 95% CI 0.58–0.89).

Conclusion

We found an increase in the use of non-GP services (nursing, rehabilitation, and psychological) but not in other health and home care services. The only differences in hospitalizations were observed according to sex. Therefore, the effect of the economic crisis, if any, seems to have been of small magnitude.

Keywords:

• COPD
• healthcare services
• population-based
• time trends
• survey
• economic crisis

Supplementary materials

Table S1 Distribution of the study populations (COPD sufferers) according to demographic and socioeconomic variables, health status, lifestyles, and health care resources use in the EHSS, 2009 and 2014

Table S2 Multivariable model to assess variables associated to health and home care services use among Spanish COPD subjects included in the EHSS 2009

Table S3 Multivariable model to assess variables associated to health and home care services use among Spanish COPD subjects included in the EHSS 2014

Table S4 Sensitivity analysis. Multivariable model to assess variables associated to health and home care services use among Spanish COPD subjects included in the EHSS 2009 and 2014 excluding monthly income

Acknowledgments

This study is part of the research funded by the FIS (Fondo de Investigaciones Sanitarias-Health Research Fund, grant number PI16/00564, Instituto de Salud Carlos III), cofinanced by the European Union through the Fondo Europeo de Desarrollo Regional (FEDER, “Una manera de hacer Europa”) and by the Grupo de Excelencia Investigadora URJC-Banco Santander Nº30VCPIGI03: Investigación traslacional en el proceso de salud – enfermedad (ITPSE).

Disclosure

The authors report no conflicts of interest in this work.