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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
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
1176-9106
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
390b5e49-fe4f-4d4f-a44a-c15978c64222
Melbye, Hasse
be60ca95-b236-48e5-8eb9-c9a153d54a8f
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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Gillespie, David
a1389d8b-011c-408e-8064-2ce4ccf3312a
Francis, Nick
9b610883-605c-4fee-871d-defaa86ccf8e
Ahmed, Haroon
880dac61-6070-4e31-9d09-ed7dbbf9a5cf
Hood, Kerenza
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Llor, Carl
a7fcfced-28f4-4771-8ca5-2c1ce2095d61
White, Patrick
aa8d0bb0-0a13-4c57-8b3b-e8fa19b46b93
Thomas-Jones, Emma
ea15d5ac-8232-4823-ab40-17bec0968520
Stanton, Helen
05e8526c-706a-4615-add9-c942abf8d12a
Sewell, Bernadette
d753e76b-592d-4abe-a4f3-c0f8aa8b41ce
Phillips, Rhiannon
197e1e95-ea7d-4867-80e0-52e5c7261a8b
Naik, Gurudutt
390b5e49-fe4f-4d4f-a44a-c15978c64222
Melbye, Hasse
be60ca95-b236-48e5-8eb9-c9a153d54a8f
Lowe, Rachel
7e234964-ecae-46b1-8021-3a6aa908d785
Kirby, Nigel
f096d265-c00e-42e0-8cd8-fb5ab470f513
Cochrane, Ann
0e3eb0e6-c171-4bdb-ab46-57aaf985e588
Bates, Janine
290a69e6-4f81-4dbe-b270-30e4155ca576
Alam, Mohammed Fasihul
209b7bf8-434f-4b2c-9815-724131f6fbe4
Butler, Christopher
8bf4cace-c34a-4b65-838f-29c2be91e434

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, 383-394. (doi:10.2147/COPD.S340710).

Record type: Article

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.

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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
ORCID for Nick Francis: ORCID iD orcid.org/0000-0001-8939-7312

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Date deposited: 04 May 2022 17:02
Last modified: 05 May 2022 01:57

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Contributors

Author: David Gillespie
Author: Nick Francis ORCID iD
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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