Daria Bukanova-Berend

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Bukanova-Berend
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Daria
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daria.bukanova-berend@unisg.ch

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    Hospitalizations and inpatient resource consumption of patients suffering from chronic disease – Past trend and forecast for Switzerland
    (Springer Science and Business Media LLC, 2025-11-24)
    Daria Bukanova-Berend  
    ;
    Thomas Campbell-James
    ;
    Justus Vogel  
    Background Chronic diseases are an increasing burden for Swiss healthcare. Demographic change aggravates the problem, with an ageing, multi-morbid population increasing the need for care while also depleting the healthcare workforce. Originally developed to assess the structural quality of and access to primary care, Potentially Avoidable Hospitalizations (PAHs) are an OECD-metric employed as an indicator of inpatient burden for various chronic diseases. So far, evidence on future PAH-burden remains limited. Aims (1) To assess the evolution of PAHs and associated resources (bed capacities, inpatient healthcare expenditures) in Switzerland for chronic obstructive pulmonary disease (COPD), asthma, congestive heart failure (CHF), hypertension and diabetes between 2012 and 2022, (2) to forecast PAHs until 2032, based on expected demographic change and (3) to explore methodologically how changes in primary care physician (PCP)-supply and countermeasures might influence future PAH-development. Methods We identified PAHs in retrospective routine hospital data and derived numbers of occupied hospital beds, based on cases’ length of stay, and inpatient healthcare expenditures, based on diagnosis-related group payments. We utilized population forecasts for Switzerland to extrapolate PAH-volume in the base scenario. Additionally, we predicted via linear regression how reduced ageing-induced PCP-availability might affect PAHs. Finally, we explored the potential impact of countermeasures, optimal Guideline-Directed Medical Therapy (GDMT)-implementation, for CHF and COPD. Results The number of PAHs across all five chronic diseases increased from 30.1 to 40.2 thousand cases between 2012 and 2019 (+ 34%) and is projected to rise to 54.9 thousand cases until 2032 (+ 37%). We project PAH-volume to increase by an additional 11% by 2032 due to changes in PCP-supply. By 2032, optimal GDMT-implementation has the potential to reduce CHF- and COPD-related PAH-volumes by 31% (95% CI: 22.23–37.60%) and 14% (95% CI: 2.17–26.02%), respectively. Conclusions Our study assesses cumulative PAH-trends and is the first to forecast future burden in Switzerland. A strong rise in PAHs and associated inpatient resources was registered for the last decade, with accelerating growth expected throughout the next. A depleting healthcare workforce may exacerbate burden. Optimal GDMT-implementation could potentially curb increases in PAHs. However, methods to reach optimal implementation require further research and policy efforts.
    Type:journal article
    Journal:BMC Health Services Research
    Volume:25
    Issue:1
    DOI:10.1186/s12913-025-13687-5
    URI:https://www.alexandria.unisg.ch/handle/20.500.14171/124740
    Scopus© Citations 3
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    What kind of self-management works and what patients need to better self-manage in case of COPD - Evidence from Swiss survey data
    (2024)
    Daria Bukanova-Berend  
    ;
    Bischof Anja Yvonne  
    ;
    Vogel, Justus  
    ;
    Geissler, Alexander  
    Objective: We aim to understand what self-management interventions and capabilities are associated with a better health status of COPD patients and what kind of support individuals with COPD need to enhance disease self-management. Methods: We obtained self-reported data from 195 COPD patients using a web-based survey. We employed OLS regressions to examine the association between health status of COPD patients measured by reversed CAT score and two self-management capabilities, i.e. smoking cessation and feeling secure in medication intake, and four self-management interventions, i.e. exchange with other COPD patients, annual flu vaccination, participation in the “Living well with COPD” education program and usage of digital health interventions. We used patient characteristics, i.e. age, gender, education, body mass index (BMI), hospitalized exacerbations in the past and number of comorbidities, as controls. For self-management indicators which showed a significant impact on patients’ health status, we conducted subgroup analyses to identify the differences in patients’ support needs. Results: Not feeling “very secure” in medication intake was associated with a lower reversed CAT score, denoting a worse health status (3.61 points lower for “Secure” (p<0.05), 5.69 points lower for “Neutral” (p<0.01), and 4.94 points lower for “Insecure” (p<0.05)). Successful smoking cessation was associated with 3.63 points higher reversed CAT score (p<0.05), denoting a better health status. The subgroups analyses showed that respondents who are not very secure in medication intake had a significantly higher need for regular tips and information on dealing with COPD and support for smoking cessation. The subgroup of current smokers expressed a significantly higher need for support for smoking cessation than former smokers. Discussion: Our study shows that smoking cessation and medication adherence are effective self-management approaches in case of COPD. Our results suggest that self-management should be personalized according to the needs of COPD patients of different subgroups.
    Type:conference contribution
    URI:https://www.alexandria.unisg.ch/handle/20.500.14171/121707
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