Health Care Utilisation and Health Needs of People with Severe COPD in the Southern Region of New Zealand: A Retrospective Case Note Review

Figures & data

Table 1. Demographics of 340 patients in the Southern District with spirometry-confirmed COPD and at least one hospital visit for an exacerbation in 2015.

		Dunedin	Southland	Other	Total
n		169	123	48	340
Female		71 (42)	55 (45)	21 (44)	147 (43)
Age (mean (SD))		72.0 (10.4)	71.0 (10.1)	72.9 (10.6)	71.8 (10.3)
Ethnicity	European	153 (93)	101 (83)	40 (95)	294 (90)
	Māori	9 (5)	17 (14)	2 (5)	28 (9)
	Pacific Peoples	3 (2)	1 (1)	0 (0)	4 (1)
	Other	0	2 (2)	0 (0)	2 (1)
	Total	165 (100)	121 (100)	42 (100)	328 (100)
Number of comorbidities	0-2	31 (21)	23 (23)	9 (24)	63 (22)
	3-5	68 (45)	43 (43)	14 (37)	125 (44)
	6-8	33 (22)	14 (14)	10 (26)	57 (20)
	>9	18 (12)	19 (19)	5 (13)	42 (15)
	Total	150 (100)	99 (100)	38 (100)	287 (100)
NZ deprivation quintile*	1	24 (15)	7 (6)	4 (9)	35 (11)
	2	31 (19)	13 (11)	18 (38)	62 (19)
	3	35 (21)	30 (25)	14 (30)	79 (24)
	4	36 (22)	39 (32)	7 (15)	82 (25)
	5	38 (23)	32 (26)	4 (9)	74 (22)
	Total	164 (100)	121 (100)	47 (100)	332 (100)
Urban area^#	Main	135 (82)	83 (69)	0 (0)	218 (66)
	Minor	9 (5)	19 (16)	26 (55)	54 (16)
	Secondary	2 (1)	0 (0)	9 (19)	11 (3)
Rural area^#	Rural centre	8 (5)	13 (11)	3 (6)	24 (7)
	Other rural	10 (6)	6 (5)	9 (19)	25 (8)
	Total	164 (100)	121 (100)	47 (100)	332 (100)
Road distance from home to hospital (km)	0-10	91 (55)	81 (67)	27 (56)	199 (60)
	10-20	46 (28)	3 (2)	6 (13)	55 (16)
	20-50	5 (3)	15 (12)	10 (21)	30 (9)
	50-100	12 (7)	18 (15)	4 (8)	34 (10)
	>100	11 (7)	4 (3)	1 (2)	16 (5)
	Total	165 (100)	121 (100)	48 (100)	334 (100)

Data given as no. of patients (%) except age (SD) (total data for age: n = 334). *NZ deprivation quintiles: level of deprivation increases from 1 to 5. ^#Defined according to Stats NZ urban/rural profile.

Table 2. Utilisation of inpatient services at Dunedin, Southland and other hospitals in the Southern District.

		Dunedin	Southland	Other	Total
Index admission type	ED only	33	18	1	52
	Inpatient	136	105	47	288
	Total	169	123	48	340
Index admission LOS (inpatient admissions only)		4.2	4.1	5.9	4.4
Mean total LOS (days) in 12 months prior to (and excluding) index admission (n = 337)		9.2	9.6	6.6	9.0
Mean no. of hospital admissions in 12 months prior to (and excluding) index admission (n = 337)		2.1	1.6	1.3	1.8
Mean total COPD LOS (days) in 12 months prior to (and excluding) index admission (n = 337)		4.7	5.7	3.1	4.8
Mean no. of hospital admissions for COPD in 12 months prior to (and excluding) index admission (n = 337)		1.1	1.1	0.7	1.0
Repeat admissions within 30 days of index admission (%) (n = 338)	All causes	33 (20)	19 (15)	8 (17)	60 (18)
	COPD	5 (3)	0 (0)	0 (0)	5 (1)
	Other resp	11 (7)	12 (10)	4 (8)	27 (8)
	Other cause	17 (10)	7 (6)	4 (8)	28 (8)

Abbreviations: ED = emergency department; LOS = length of stay; resp = respiratory.

Table 3. Utilisation of outpatient and allied health services at Dunedin, Southland and other hospitals in the Southern District.

	Dunedin	Southland	Other	Total
All medical specialists	5.0	5.4	3.5	4.9
Respiratory specialists	0.7	1.0	0.8	0.8
Total allied health contacts	13.8	16.6	11.8	14.5
Respiratory specialist nurse	2.4	4.9	2.6	3.3
Palliative care nurse	1.1	0.1	0.0	0.6
District nurse	5.1	8.2	4.0	6.0
Physiotherapist	1.1	0.4	1.9	1.0
Occupational therapist	0.7	0.4	1.2	0.7
Health support worker	0.2	0.0	0.3	0.1
Social worker	0.1	0.1	0.3	0.1
Cultural support worker	0.4	0.9	0.0	0.6
Others	2.9	1.5	1.4	2.2

Values are mean number of contacts in the 12 months prior to and 3 months after the index admission (n = 340).

Table 4. Comparison of health service utilisation by Māori and NZ Europeans in the study cohort.

	Ethnicity
	Māori	NZ European
Index admission LOS (days) (inpatient admissions only) (n = 21 for Māori, n = 246 for NZ European)	4.0	4.5
Total LOS (days) in 12 months prior to (and excluding) index admission (n = 28 for Māori, n = 285 for NZ European)	9.8	9.2
Total COPD LOS (days) in 12 months prior to (and excluding) index admission (n = 28 for Māori, n = 285 for NZ European)	4.7	5.1
No. of hospital admissions in 12 months prior to (and excluding) index admission (n = 28 for Māori, n = 285 for NZ European)	1.9	1.9
No. of hospital admissions for COPD in 12 months prior to (and excluding) index admission (n = 28 for Māori, n = 285 for NZ European)	1.0	1.1
No. of contacts with all medical specialists	6.1	4.8
No. of contacts with respiratory specialists	1.1	0.8
No. of contacts with respiratory specialist nurse	9.1	6.0
No. of contacts with palliative care nurse	1.0	5.4
No. of contacts with district nurse	21.0	21.8

Values are means. n = 28 for Māori and n = 287 for NZ Europeans unless otherwise stated.

Abbreviation: LOS = length of stay; NZ = NZ.

Table 5. Numbers of Māori and NZ European men and women in the study cohort with cardiovascular and other relevant comorbidities (percentages are given in brackets).

	Māori						NZ European
	Male		Female		Total		Male		Female		Total
	(n = 13)		(n = 8)		(n = 21)		(n = 134)		(n = 111)		(n = 245)
MI	0	(0)	0	(0)	0	(0)	17	(13)	5	(5)	22	(9)
Heart failure	2	(15)	1	(13)	3	(14)	10	(7)	10	(9)	20	(8)
Hypertension	9	(69)	3	(38)	12	(57)	51	(38)	47	(42)	98	(40)
IHD	6	(46)	0	(0)	6	(29)	38	(28)	21	(19)	59	(24)
Other CVD	3	(23)	2	(25)	5	(24)	46	(34	41	(37)	87	(36)
Stroke	1	(8)	0	(0)	1	(5)	10	(7)	9	(8)	19	(8)
GORD	0	(0)	2	(25)	2	(10)	23	(17)	15	(14)	38	(16)
Type 2 DM	1	(8)	0	(0)	1	(5)	26	(19)	10	(9)	36	(15)
Osteoarthritis	1	(8)	0	(0)	1	(5)	10	(7)	12	(11)	22	(9)
Osteoporosis	2	(15)	0	(0)	2	(10)	12	(9)	11	(10)	23	(9)
Cancer	5	(38)	1	(13)	6	(29)	32	(24)	20	(18)	52	(21)
Depression	0	(0)	1	(13)	1	(5)	16	(12)	10	(9)	26	(11)
Anxiety	0	(0)	1	(13)	1	(5)	15	(11)	11	(10)	26	(11)
Other mental health	0	(0)	0	(0)	0	(0)	10	(7)	7	(6)	17	(7)

Abbreviations: NZ = NZ; MI = myocardial infarction; IHD = ischaemic heart disease; CVD = cardiovascular disease; GORD = gastro-oesophageal reflux disease; DM = diabetes mellitus.