Background There is high interest in strategies for improving early detection of chronic obstructive pulmonary disease (COPD). These strategies often rely on opportunistic encounters between patients with undiagnosed COPD and the healthcare system; however, the frequency of these encounters is currently unknown. Methods We used administrative health data for the province of British Columbia, Canada, from 1996 to 2015. We identified patients with COPD using a validated case definition, and assessed their visits to pharmacists, primary care and specialist physicians in the 5 years prior to the initial diagnosis of COPD. We used generalised linear models to compare the rate of outpatient visits between COPD and non-COPD comparator subjects matched on age, sex and socioeconomic status. Results We assessed 112 635 COPD and non-COPD pairs (mean 68.6 years, 51.0% male). Patients with COPD interacted with pharmacists most frequently in the 5 years before diagnosis (mean 14.09, IQR 4–17 visits/year), followed by primary care (10.29, IQR 4–13 visits/year) and specialist (8.11, IQR 2–11 visits/year) physicians. In the 2 years prior to diagnosis, 72.1% of patients with COPD had a respiratory-related primary care visit that did not result in a COPD diagnosis. Compared with non-COPD subjects, patients with COPD had higher rates of primary care (rate ratio (RR) 1.40, 95% CI 1.39 to 1.41), specialist (RR 1.35, 95% CI 1.34 to 1.37) and pharmacist (RR 1.62, 95% CI 1.60 to 1.63) encounters. Conclusions Patients with COPD used higher rates of outpatient services before diagnosis than non-COPD subjects. Case detection technologies implemented in pharmacy or primary care settings have opportunities to diagnose COPD earlier.

中文翻译：

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COPD 诊断前的医疗保健系统遭遇：基于注册表的纵向队列研究

背景 人们对改善慢性阻塞性肺疾病 (COPD) 早期检测的策略非常感兴趣。这些策略通常依赖于未确诊 COPD 患者与医疗保健系统之间的机会性接触；然而，这些遭遇的频率目前未知。方法 我们使用了 1996 年至 2015 年加拿大不列颠哥伦比亚省的行政健康数据。我们使用经过验证的病例定义来识别 COPD 患者，并评估他们在 5 年之前对药剂师、初级保健和专科医生的访问COPD的初步诊断。我们使用广义线性模型来比较年龄、性别和社会经济地位匹配的 COPD 和非 COPD 比较对象之间的门诊就诊率。结果 我们评估了 112 635 对 COPD 和非 COPD 对（平均 68. 6 岁，51.0% 男性）。COPD 患者在诊断前 5 年内与药剂师互动最频繁（平均 14.09，IQR 4-17 次/年），其次是初级保健（10.29，IQR 4-13 次/年）和专科医生（8.11，IQR 2- 11 次访问/年）医生。在诊断前的 2 年内，72.1% 的 COPD 患者进行了与呼吸相关的初级保健就诊，但未导致 COPD 诊断。与非 COPD 受试者相比，COPD 患者的初级保健（比率 (RR) 1.40，95% CI 1.39 至 1.41）、专科医生（RR 1.35，95% CI 1.34 至 1.37）和药剂师（RR 1.62， 95% CI 1.60 到 1.63) 遭遇。结论 COPD 患者在诊断前使用的门诊服务率高于非 COPD 患者。