Üniversite Hastanesi ve Devlet Hastanesi'nde İzlenen Kronik Obtrüktif Akciğer Hastalığı Olan Hastaların Karşılaştırılması

Amaç: Kronik Obstrüktif Akciğer Hastalığı (KOAH) önemli bir mortalite ve morbidite nedenidir ve ülke ekonomilerine ciddi yükler getirmektedir. Devlet ve üniversite hastanelesinde, KOAH alevlenmesi tanısı ile yatırılan hastalarda KOAH'ın ekonomik yükünü etkileyebilecek muayene, tedavi ve yaklaşım farklılıklarını inceledik. Gereç ve Yöntemler: Üniversite hastanesinde(ÜH) tedavi gören 104 hasta ile Devlet Hastanesinde(SH) KOAH nedeniyle tedavi gören 102 hasta çalışmaya dahil edildi.İki hastane arasındaki hekimlerin yaklaşım ve maliyet analizleri karşılaştırıldı. Bulgular ve Sonuç: SH'de yaş ortalaması daha yüksekti(p=0,01). UH'de komorbiditeler daha yüksekti(p<0,001).UH'de nebulizer tedavisi alan hasta sayısı(p=0,02) ve toplam sayı kullanılan nebulizatör ilaç miktarı SH'de daha yüksekti(p<0,001). İntravenöz(IV) ilaç kullanılan hasta sayısı ve kullanılan toplam IV ilaç sayısı SH'de daha yüksekti(p<0,001).Toplam İM sayısı UH'de daha fazlaydı(p<0,001). UH'de kullanılan oral antibiyotik sayısı daha fazlaydı(p<0,001).UH'li hastalarda penisilinler,makrolidler,penisilin-makrolitler daha fazla kullanıldı.Sefalosporinler ve kinolonlar SH'de daha fazla kullanıldı (p<0,001). SH'de inhaler kortikosteroid(ICS)(p<0,001), nebulizer formda salbutamol+ipratropiumbromur kombinasyonu(p<0,001) ve daha fazla hastada IV teofilin kullanıldı(p=0,01). UH'de nebulizer formda salbutamol kullanımı daha fazlaydı(p<0,001).Spirometri,arter kan gazı analizi(sırasıyla p<0,001,p<0,001),akciğer grafisi UH'de daha fazla yapıldı(p=0,02).Toplam maliyet(p<0,001),toplam ve günlük ilaç maliyetleri SH'de daha fazlaydı(p<0,001).UH'de ilaç dışı maliyetler daha fazlaydı(p=0,02). KOAH alevlenmesi ile hastaneye yatırılan hastalarda maliyet üzerine kılavuzlara uyumun çok önemli bir etkisi olduğuna inanıyoruz.

Anahtar Kelimeler:

KOAH, devlet hastanesi, ekonomik yük, ilaç, üniversite hastanesi

Comparison of Patients with Chronic Obstructive Pulmonary Disease that Hospitalized in University Hospital and State Hospital

Aim:Chronic Obstructive Pulmonary Disease(COPD) is an important mortality and morbidity reason and brings serious burdens to the economies of countries.We analyzed differences in examination,treatment and approach that may affect the economic burden of COPD in hospitalized patients with a diagnosis of COPD exacerbation in state and university hospitals Material and Methods:104 patients who were being treated in university hospital(UH) and 102 patients in State Hospital(SH) because of COPD were included.The difference in approach of physicians and cost analysis between two hospitals were compared Results and Conslusion:The average age was higher in SH(p=0,01).Comorbities were higher in UH(p<0.001).The number of patients who received nebulizer treatment(p=0,02) in UH and total number of nebulizer medication used was higher in SH(p<0,001).The number of patients for whom intravenous(IV) medication was used and the number of total IV medication used was higher in SH(p<0,001).The total number of IM medication used was higher in UH(p<0,001).The number oral antibiotics used was higher in UH(p<0,001).The penicillins,macrolids,penicillin-macrolids were used more in patients in UH.The cephalosporins and quinolons were used more in SH(p<0,001).Inhaler corticosteroid(ICS)(p<0,001),salbutamol+ipratropiumbromur combination in nebulizer form(p<0,001) and IV teophilin was used in more patients in SH(p=0,01).The use of salbutamol in nebulizer form was more in UH(p<0,001).Spirometry,arterial blood gas analysis(respectively p<0,001,p<0,001),chest radiography was applied more in UH(p=0,02).Total cost(p<0,001),total and daily medication costs was more in SH(p<0,001).Costs other than medication was more in UH(p=0,02).We believe that adherence to the guidelines has a very important effect on cost in patients hospitalized with COPD exacerbation

Keywords:

COPD, drug, economic burden, state hospital, university hospital,

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