COPD Rehospitalization Influenced by Psychological Symptoms

Patients with chronic obstructive pulmonary disease (COPD) who also have psychological symptoms like depression, anxiety, psychosis, or alcohol or drug abuse may be more likely to be admitted to the hospital with complications, according to a study published in Chest.

Researchers from the University of Texas Medical Branch at Galveston studied Medicare beneficiaries diagnosed with COPD between 2001 and 2011 that were hospitalized with COPD as their primary discharge diagnosis or respiratory failure as the secondary diagnosis. The researchers hypothesized that psychological disorders — like depression, anxiety, psychosis, alcohol and drug abuse – would be independently associated with an increased risk of 30 day hospital readmission in COPD patients.

From a total of 135,498 patients, the researchers learned that 80,888 COPD patients were hospitalized with complications. Of those, 30,218 patients (22 percent) had one or more psychological condition. Those patients’ rate of early readmission was between 5 to 14 percent higher than patients who did not have psychological conditions. Patients with psychological conditions readmitted to the hospital had longer initial length of time in the hospital as well as lower rates of outpatient follow up visits within the first month after discharge.

Patients who suffered from alcohol abuse, psychosis, or more than one psychological condition, or patients that had a low income level, had even higher readmission rates."

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,” study researcher Gurinder Singh, a fellow in the UTMB department of internal medicine, division of pulmonary critical care and sleep medicine explained in a press release.

“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.”

Re-hospitalization among elderly COPD patients costs nearly a billion dollars annually, the statement continued. Additionally, the statement explained that the US Centers for Medicare and Medicaid Services penalizes hospitals when they have excess levels of early hospital readmissions for certain conditions under the Hospital Readmission Reduction Program, which includes COPD, heart attack, congestive heart failure, and pneumonia.