In a study recently published in the journal CHEST, a team of researchers from The University of Texas Medical Branch at Galveston determined that people with a psychological disorder such as anxiety, psychosis, depression, or alcohol/drug abuse are at increased risk of being readmitted to a hospital for complications of chronic obstructive pulmonary disease (COPD).
“These psychological disorders are more likely to predict early readmission than other significant factors,” said Gurinder Singh, a fellow in the UTMB department of internal medicine, division of pulmonary critical care and sleep medicine.
COPD affects 12 to 24 million people and is the third leading cause of death in the United States. Every year, thousands of patients have acute COPD flare-ups, which require hospitalization. Among older adults, evidence has shown that one in five of these patients require readmission within 30 days of discharge.
The reasons for hospital readmission have been found to be related to disease severity, existence of comorbid conditions, presence of psychological conditions and outpatient follow-up.
Studies have shown that about 55% of the patients with COPD suffer from psychological disorders such as anxiety or depression. However, the association between these disorders’ impact on COPD hospital readmission remains unclear.
In the study titled “Association of psychological disorders with 30–day readmission rates in patients with Chronic Obstructive Pulmonary Disease,” the team of researchers analyzed data from COPD Medicare beneficiaries that were diagnosed from 2001 to 2011 and who were hospitalized with a primary discharge diagnosis of COPD or respiratory with secondary diagnosis for COPD.
The researchers examined if psychological disorders including anxiety, psychosis, depression, alcohol abuse and drug abuse were associated with an increased risk of 30-day readmission in patients who were hospitalized for COPD. They found that within the analyzed time period, a total of 135,498 hospitalizations occurred among a population of 80,088 fee-for-service Medicare beneficiaries.
Of these, total of 30,218 (22.30%) COPD patients were found to have one or more psychological conditions. Results showed that the odds of 30-day readmission were higher in COPD patients who had comorbid anxiety, psychosis, depression, alcohol abuse and drug abuse in comparison to those with COPD who did not have these psychological conditions. The researchers also found that the presence of these conditions increased the amount of variation in 30-day readmission attributed to patient characteristics by 37%.
“This is likely related to the limited ability of these patients to handle the COPD, poor social support or community resources and non-adherence with treatment,” said Singh. “Because of the complexity of this situation, hospitals and health-care providers need more guidance to reduce readmission in patients with COPD, and it may not be practical to penalize hospitals for higher early readmission rates. More studies are needed in this area.”