Abstract
BACKGROUND: Patients often delay care for COPD exacerbations, delaying recovery and increasing the risk of emergency visits. OBJECTIVE: This study examined the relative importance of access to care and perception of need for care in the decision to seek care for COPD exacerbations. DESIGN: A 1-year prospective cohort study. PARTICIPANTS: A total of 410 patients with COPD in the Department of Veterans Affairs (VA). MAIN MEASURES: Participants completed baseline spirometry and questionnaires regarding social support, comorbidity, cognition, psychological symptoms, perceived access to care, and perceived need for care. Participants were contacted every 2 weeks to identify exacerbations, and information was collected regarding symptoms, care seeking, and health care utilization. For each exacerbation, participants completed the Response to Symptoms Questionnaire regarding emotional and cognitive responses to the exacerbations. A shared-frailty survival model was used to estimate the correlates of time to seeking care. KEY RESULTS: There were 1094 exacerbations among 356 participants; mean age of these patients was 69.4 (SD 7.4), 4.2% were women, and mean FEV(1)% predicted was 44.2% (SD 18.7). In adjusted analyses, those who were very or extremely anxious in response to symptoms were more likely to seek care; those with very or extremely high perceived control over symptoms were less likely to seek care, and access to a VA pulmonary provider was associated with earlier care seeking. CONCLUSIONS: In the VA, patients' perceived need for care was an important determinant of care seeking for COPD exacerbations. Understanding and addressing the emotional and cognitive responses to worsening breathing symptoms may help inform programs for prompt and appropriate treatment of COPD exacerbations.