Associations with post-consultation health-status in primary care managed acute exacerbation of COPD
Associations with post-consultation health-status in primary care managed acute exacerbation of COPD
Background: It has been demonstrated that antibiotic prescribing for Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD) can be safely reduced in primary care when general practitioners have access to C-reactive protein (CRP) rapid testing. Aim: To investigate the factors associated with post-consultation COPD health status in patients presenting with AECOPD in this setting. Design and Setting: A cohort study of patients enrolled in a randomised controlled trial. Patients aged 40+ years with a clinical diagnosis of COPD who presented in primary care across England and Wales with an AECOPD were included. Methods: Participants were contacted for follow-up at one-and two-weeks by phone and attended the practice four weeks after the index consultation. The outcome of interest was the Clinical COPD Questionnaire (CCQ) score. Multivariable multilevel linear regression models fitted to examine the factors associated with COPD health status in the four-weeks following consultation for an AECOPD. Results: A total of 649 patients were included, with 1947 CCQ total scores analysed. Post-consultation CCQ total scores were significantly higher (worse) in participants with diabetes (adjusted mean difference [AMD]=0.26; 95% confidence interval (CI) 0.08– 0.45), obese patients compared to those with normal body mass index (AMD = 0.25, 95% CI 0.07–0.43), and those who were prescribed oral antibiotics in the prior 12 months (AMD = 0.26; 95% CI 0.11–0.41), but only the two latter associations remained after adjusting for other sociodemographic variables. Conclusion: COPD health status was worse in the four weeks following primary care consultation for AECOPD in patients with obesity and those prescribed oral antibiotics in the preceding year.
Chronic obstructive, Health status, Primary Health Care, Pulmonary disease, Symptom exacerbation
383-394
Gillespie, David
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Francis, Nick
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Ahmed, Haroon
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Hood, Kerenza
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Llor, Carl
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White, Patrick
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Thomas-Jones, Emma
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Stanton, Helen
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Sewell, Bernadette
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Phillips, Rhiannon
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Naik, Gurudutt
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Melbye, Hasse
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Lowe, Rachel
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Kirby, Nigel
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Cochrane, Ann
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Bates, Janine
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Alam, Mohammed Fasihul
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Butler, Christopher
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16 February 2022
Gillespie, David
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Francis, Nick
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Ahmed, Haroon
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Hood, Kerenza
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Llor, Carl
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White, Patrick
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Thomas-Jones, Emma
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Stanton, Helen
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Sewell, Bernadette
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Phillips, Rhiannon
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Naik, Gurudutt
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Melbye, Hasse
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Lowe, Rachel
7e234964-ecae-46b1-8021-3a6aa908d785
Kirby, Nigel
f096d265-c00e-42e0-8cd8-fb5ab470f513
Cochrane, Ann
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Bates, Janine
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Alam, Mohammed Fasihul
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Butler, Christopher
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Gillespie, David, Francis, Nick, Ahmed, Haroon, Hood, Kerenza, Llor, Carl, White, Patrick, Thomas-Jones, Emma, Stanton, Helen, Sewell, Bernadette, Phillips, Rhiannon, Naik, Gurudutt, Melbye, Hasse, Lowe, Rachel, Kirby, Nigel, Cochrane, Ann, Bates, Janine, Alam, Mohammed Fasihul and Butler, Christopher
(2022)
Associations with post-consultation health-status in primary care managed acute exacerbation of COPD.
International Journal of COPD, 17, .
(doi:10.2147/COPD.S340710).
Abstract
Background: It has been demonstrated that antibiotic prescribing for Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD) can be safely reduced in primary care when general practitioners have access to C-reactive protein (CRP) rapid testing. Aim: To investigate the factors associated with post-consultation COPD health status in patients presenting with AECOPD in this setting. Design and Setting: A cohort study of patients enrolled in a randomised controlled trial. Patients aged 40+ years with a clinical diagnosis of COPD who presented in primary care across England and Wales with an AECOPD were included. Methods: Participants were contacted for follow-up at one-and two-weeks by phone and attended the practice four weeks after the index consultation. The outcome of interest was the Clinical COPD Questionnaire (CCQ) score. Multivariable multilevel linear regression models fitted to examine the factors associated with COPD health status in the four-weeks following consultation for an AECOPD. Results: A total of 649 patients were included, with 1947 CCQ total scores analysed. Post-consultation CCQ total scores were significantly higher (worse) in participants with diabetes (adjusted mean difference [AMD]=0.26; 95% confidence interval (CI) 0.08– 0.45), obese patients compared to those with normal body mass index (AMD = 0.25, 95% CI 0.07–0.43), and those who were prescribed oral antibiotics in the prior 12 months (AMD = 0.26; 95% CI 0.11–0.41), but only the two latter associations remained after adjusting for other sociodemographic variables. Conclusion: COPD health status was worse in the four weeks following primary care consultation for AECOPD in patients with obesity and those prescribed oral antibiotics in the preceding year.
Text
COPD-340710-associations-with-post-consultation-health-status-in-primary
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More information
Accepted/In Press date: 20 December 2021
Published date: 16 February 2022
Keywords:
Chronic obstructive, Health status, Primary Health Care, Pulmonary disease, Symptom exacerbation
Identifiers
Local EPrints ID: 456514
URI: http://eprints.soton.ac.uk/id/eprint/456514
ISSN: 1176-9106
PURE UUID: 8ecb1257-4657-4955-b302-e711c27bc735
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Date deposited: 04 May 2022 17:02
Last modified: 18 Mar 2024 03:54
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Contributors
Author:
David Gillespie
Author:
Haroon Ahmed
Author:
Kerenza Hood
Author:
Carl Llor
Author:
Patrick White
Author:
Emma Thomas-Jones
Author:
Helen Stanton
Author:
Bernadette Sewell
Author:
Rhiannon Phillips
Author:
Gurudutt Naik
Author:
Hasse Melbye
Author:
Rachel Lowe
Author:
Nigel Kirby
Author:
Ann Cochrane
Author:
Janine Bates
Author:
Mohammed Fasihul Alam
Author:
Christopher Butler
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