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Licskai C, Hussey A, Rowley V, Ferrone M, Lu Z, Zhang K, Terebessy E, Scarffe A, Sibbald S, Faulds C, O'Callahan T, To T. Quantifying sustained health system benefits of primary care-based integrated disease management for COPD: a 6-year interrupted time series study. Thorax 2024; 79:725-734. [PMID: 38889973 DOI: 10.1136/thorax-2023-221211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 05/16/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Severe exacerbation of chronic obstructive pulmonary disease (COPD) is a trajectory-changing life event for patients and a major contributor to health system costs. This study evaluates the real-world impact of a primary care, integrated disease management (IDM) programme on acute health service utilisation (HSU) in the Canadian health system. METHODS Interrupted time series analysis using retrospective health administrative data, comparing monthly HSU event rates 3 years prior to and 3 years following the implementation of COPD IDM. Primary outcomes were COPD-related hospitalisation and emergency department (ED) visits. Secondary outcomes included hospital bed days and all-cause HSU. RESULTS There were 2451 participants. COPD-related and all-cause HSU rates increased in the 3 years prior to IDM implementation. With implementation, there was an immediate decrease (month 1) in COPD-related hospitalisation and ED visit rates of -4.6 (95% CI: -7.76 to -1.39) and -6.2 (95% CI: -11.88, -0.48) per 1000 participants per month, respectively, compared with the counterfactual control group. After 12 months, COPD-related hospitalisation rates decreased: -9.1 events per 1000 participants per month (95% CI: -12.72, -5.44) and ED visits -19.0 (95% CI: -25.50, -12.46). This difference nearly doubled by 36 months. All-cause HSU also demonstrated rate reductions at 12 months, hospitalisation was -10.2 events per 1000 participants per month (95% CI: -15.79, -4.44) and ED visits were -30.4 (95% CI: -41.95, -18.78). CONCLUSIONS Implementation of COPD IDM in a primary care setting was associated with a changed trajectory of COPD-related and all-cause HSU from an increasing year-on-year trend to sustained long-term reductions. This highlights a substantial real-world opportunity that may improve health system performance and patient outcomes.
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Affiliation(s)
- Christopher Licskai
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- Asthma Research Group Windsor-Essex County Inc, Windsor, Ontario, Canada
| | - Anna Hussey
- Asthma Research Group Windsor-Essex County Inc, Windsor, Ontario, Canada
| | - Véronique Rowley
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Madonna Ferrone
- Asthma Research Group Windsor-Essex County Inc, Windsor, Ontario, Canada
- Hôtel-Dieu Grace Healthcare, Windsor, Ontario, Canada
| | - Zihang Lu
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Kimball Zhang
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Emilie Terebessy
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Andrew Scarffe
- Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
| | - Shannon Sibbald
- Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Cathy Faulds
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Asthma Research Group Windsor-Essex County Inc, Windsor, Ontario, Canada
| | - Tim O'Callahan
- Asthma Research Group Windsor-Essex County Inc, Windsor, Ontario, Canada
- Amherstburg Family Health Team, Amherstburg, Ontario, Canada
| | - Teresa To
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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Hafid S, Freeman K, Aubrey-Bassler K, Queenan J, Drummond N, Lawson J, Vanstone M, Nicholson K, Lussier MT, Mangin D, Howard M. Describing primary care patterns before and during the COVID-19 pandemic across Canada: a quasi-experimental pre-post design cohort study using national practice-based research network data. BMJ Open 2024; 14:e084608. [PMID: 38772895 PMCID: PMC11110591 DOI: 10.1136/bmjopen-2024-084608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/18/2024] [Indexed: 05/23/2024] Open
Abstract
OBJECTIVE The objective was to analyse how the pandemic affected primary care access and comprehensiveness in chronic disease management by comparing primary care patterns before and during the early COVID-19 pandemic. DESIGN We conducted a quasi-experimental pre-post design cohort study and reported indicators for the 21 months before and after the onset of the COVID-19 pandemic. SETTING We used electronic medical record data from primary care clinics enrolled in the Canadian Primary Care Sentinel Surveillance Network from 1 January 2018 to 31 December 2021. POPULATION The study population included patients (n=919 928) aged 18 years or older with at least one primary care contact from 12 March 2018 to 12 March 2020, in Canada. OUTCOME MEASURES The study indicators included three indicators measuring access to primary care (encounters, blood pressure measurements and lab tests) and three for comprehensiveness (diagnoses, non-COVID-19 vaccines administered and referrals). RESULTS 67.3% of the cohort was aged ≥40 years, 56.4% were female and 53.5% were from Ontario, Canada. Fewer patients received an encounter during the pandemic (91.5% to 81.5%), while the median (IQR) number of encounters remained the same (5 (2-1)) for those with access. Fewer patients received a blood pressure measurement (47.9% to 31.8%), and patients received fewer measurements during the pandemic (2 (1-4) to 1 (0-2)). CONCLUSIONS Encounters with primary care remained consistent during the pandemic, but in-person care, such as lab tests and blood pressure measurements, decreased. In-person care indicators followed temporally to national COVID-19 case counts during the pandemic.
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Affiliation(s)
- Shuaib Hafid
- Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Karla Freeman
- Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - John Queenan
- Family Medicine, Queen's University, Kingston, Ontario, Canada
| | - Neil Drummond
- Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Lawson
- Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Meredith Vanstone
- Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Kathryn Nicholson
- Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Marie-Thérèse Lussier
- Médecine de famille et de médecine d'urgence, Université de Montréal, Montréal, Québec, Canada
| | - Dee Mangin
- Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Michelle Howard
- Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Ferrera MC, Lopez CL, Murray S, Jain RG, Labaki WW, Make BJ, Han MK. Risk Factors for Chronic Obstructive Pulmonary Disease Exacerbations among Individuals without a History of Recent Exacerbations: A COPDGene Analysis. Ann Am Thorac Soc 2024; 21:421-427. [PMID: 37796613 PMCID: PMC10913771 DOI: 10.1513/annalsats.202209-751oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 10/04/2023] [Indexed: 10/07/2023] Open
Abstract
Rationale: Acute exacerbations of chronic obstructive pulmonary disease (AE-COPD) are detrimental events in the natural history of COPD, but the risk factors associated with future exacerbations in the absence of a history of recent exacerbations are not fully understood. Objectives: To identify risk factors for COPD exacerbations among participants in the Genetic Epidemiology of COPD Study (COPDGene) without a history of exacerbation in the previous year. Methods: We identified participants with a smoking history enrolled in COPDGene who had COPD (defined as forced expiratory volume in 1 second [FEV1]/forced vital capacity < 0.70), no exacerbation in the year before their second study site visit, and who completed at least one longitudinal follow-up questionnaire in the following 36 months. We used univariable and multivariable zero-inflated negative binomial regression models to identify risk factors associated with increased rates of exacerbation. Each risk factor's regression coefficient (β) was rounded to the nearest 0.25 and incorporated into a graduated risk score. Results: Among the 1,528 participants with a smoking history and COPD enrolled in COPDGene without exacerbation in the year before their second study site visit, 508 participants (33.2%) had at least one moderate or severe exacerbation in the 36 months studied. Gastroesophageal reflux disease, chronic bronchitis, high symptom burden (as measured by Modified Medical Research Council Dyspnea Scale and COPD Assessment Test), and lower FEV1% predicted were associated with an increased risk of exacerbation. Each 1-point increase in our graduated risk score was associated with a 25-30% increase in exacerbation rate in the 36 months studied. Conclusions: In patients with COPD without a recent history of exacerbations, gastroesophageal reflux disease, chronic bronchitis, high symptom burden, and lower lung function are associated with increased risk of future exacerbation using a simple risk score that can be used in clinical practice.
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Affiliation(s)
- Michael C. Ferrera
- Division of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | | | - Renu G. Jain
- GlaxoSmithKline, Research Triangle Park, North Carolina; and
| | - Wassim W. Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
| | - Barry J. Make
- Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, Colorado
| | - MeiLan K. Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
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De Miguel-Díez J, Fernández-Villar A, Doña Díaz E, Padilla Bernáldez M, Trillo-Calvo E, Molina París J, Barrecheguren M, Valero Pérez JM, Ramírez Prieto MT. Chronic Obstructive Lung Disease: Treatment Guidelines and Recommendations for Referral and Multidisciplinary Continuity of Care. J Clin Med 2024; 13:303. [PMID: 38256437 PMCID: PMC10815941 DOI: 10.3390/jcm13020303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/25/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024] Open
Abstract
Chronic Obstructive Pulmonary Disease (COPD) constitutes a major public health problem, and it is anticipated that its prevalence will continue to increase in the future. Its progressive nature requires a continuous and well-coordinated care approach. The follow-up for COPD should primarily focus on disease screening and control, which includes monitoring of pulmonary function, prevention of exacerbations, identification of aggravating factors and comorbidities, as well as ensuring treatment adequacy and adherence. However, existing clinical practice guidelines and consensus documents offer limited recommendations for the follow-up. In this context, we undertake a review of COPD treatment and the continuity of care recommendations endorsed by several scientific societies. Moreover, we underscore the importance of the involvement of nursing and community pharmacy in this process, as well as the utilization of quality indicators in the provision of care for the disease.
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Affiliation(s)
- Javier De Miguel-Díez
- Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28007 Madrid, Spain
- Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Alberto Fernández-Villar
- Servicio de Neumología, Hospital Álvaro Cunqueiro, Grupo NeumoVigo, Instituto de Investigación Sanitaria Galicia Sur, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 36312 Vigo, Spain;
| | - Esperanza Doña Díaz
- Unidad de Asistencia al Paciente EPOC, UGC Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain;
| | | | - Eva Trillo-Calvo
- Institute for Health Research Aragón, Centro de Salud Campo de Belchite, 50130 Belchite, Spain;
| | - Jesús Molina París
- Centro de Salud Francia, Dirección Asistencial Oeste, 28943 Fuenlabrada, Spain;
| | - Miriam Barrecheguren
- Servicio de Neumología, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain;
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Stöber A, Marijic P, Kurz C, Schwarzkopf L, Kirsch F, Schramm A, Leidl R. Does uptake of specialty care affect HRQoL development in COPD patients beneficially? A difference-in-difference analysis linking claims and survey data. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:1561-1573. [PMID: 36637677 PMCID: PMC10550862 DOI: 10.1007/s10198-022-01562-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND There is an evidence gap on whether the choice of specialty care beneficially affects health-related quality of life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD). This study analyzes how newly initiated pulmonologist care affects the generic and disease-specific HRQoL in COPD patients over a period of 1 year. METHODS We linked claims data with data from two survey waves to investigate the longitudinal effect of specialty care on HRQoL using linear Difference-in-Difference models based on 1:3 propensity score matched data. Generic HRQoL was operationalized by EQ-5D-5L visual analog scale (VAS), and disease-specific HRQoL by COPD assessment test (CAT). Subgroup analyses examined COPD patients with low (GOLD AB) and high (GOLD CD) exacerbation risk. RESULTS In contrast to routine care patients, pulmonologists' patients (n = 442) experienced no significant deterioration in HRQoL (VAS - 0.0, p = 0.9870; CAT + 0.5, p = 0.0804). Models unveiled a small comparative advantage of specialty care on HRQoL (mean change: CAT - 0.8, VAS + 2.9), which was especially pronounced for GOLD AB (CAT - 0.7; VAS + 3.1). CONCLUSION The uptake of pulmonologist care had a statistically significant, but not clinically relevant, beneficial impact on the development of HRQoL by slowing down overall HRQoL deterioration within 1 year. Including specialty care more appropriately in COPD management, especially at lower disease stages (GOLD AB), could thus improve patients' health outcome.
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Affiliation(s)
- Alisa Stöber
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Munich, Germany.
- Pettenkoffer School of Public Health, Munich, Germany.
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-University Munich (LMU), Munich, Germany.
| | - Pavo Marijic
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Munich, Germany
- Pettenkoffer School of Public Health, Munich, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-University Munich (LMU), Munich, Germany
| | - Christoph Kurz
- Munich Center of Health Sciences (MC-Health), Institute for Health Economics and Management, Ludwig-Maximilians-University Munich (LMU), Munich, Germany
| | - Larissa Schwarzkopf
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Munich, Germany
- Pettenkoffer School of Public Health, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
- Institut Fuer Therapieforschung (IFT), Working Group Therapy and Health Services Research, Munich, Germany
| | - Florian Kirsch
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Munich, Germany
- Service Center of Health Care Management, AOK Bayern, Regensburg, Germany
| | - Anja Schramm
- Service Center of Health Care Management, AOK Bayern, Regensburg, Germany
| | - Reiner Leidl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Munich, Germany
- Munich Center of Health Sciences (MC-Health), Institute for Health Economics and Management, Ludwig-Maximilians-University Munich (LMU), Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
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Butler SJ, Louie AV, Sutradhar R, Paszat L, Brooks D, Gershon AS. Palliative Care Among Lung Cancer Patients With and Without COPD: A Population-Based Cohort Study. J Pain Symptom Manage 2023; 66:611-620.e4. [PMID: 37619760 DOI: 10.1016/j.jpainsymman.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023]
Abstract
CONTEXT Lung cancer patients with chronic obstructive pulmonary disease (COPD) may have greater palliative care needs due to poor prognosis and symptom burden. OBJECTIVES We sought to compare the provision of timely palliative care and symptom burden by COPD status. METHODS We performed a retrospective, population-based cohort study of individuals diagnosed with lung cancer in Ontario, Canada (2009-2019) using health administrative databases and cancer registries. The impact of COPD on the probability of receiving palliative care was determined accounting for dying as a competing event, overall and stratified by stage. The provision of palliative care for patients with severe symptoms (Edmonton Symptom Assessment Scale score ≥ 7), location of the first palliative care visit and symptom severity were compared by COPD status. RESULTS A total of 74,993 patients were included in the study (48% of patients had available symptom data). At the time of lung cancer diagnosis, 50% of patients had COPD. Stage I-III patients with COPD were more likely to receive palliative care (adjusted Hazard Ratio (HR)s: 1.05-1.31) with no difference for stage IV (1.02, 95% CI: 1.00-1.04). Despite having severe symptoms, very few patients with early-stage disease received palliative care (Stage I: COPD-23% vs. no COPD-18%, SMD = 0.12). Most patients (84%) reported severe symptoms and COPD worsened symptom burden, especially among early-stage patients. CONCLUSION COPD impacts the receipt of palliative care and symptom burden for patients with early-stage lung cancer. Many patients with severe symptoms did not receive palliative care, suggesting unmet needs among this vulnerable population.
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Affiliation(s)
- Stacey J Butler
- Institute of Medical Sciences (S.J.B., A.S.G.), University of Toronto, Toronto, ON, Canada; ICES (S.J.B., R.K., L.P., A.S.G.), Toronto, ON, Canada; Sunnybrook Research Institute (S.J.B., A.V.L., R.S., L.P., A.S.G.), Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Alexander V Louie
- Sunnybrook Research Institute (S.J.B., A.V.L., R.S., L.P., A.S.G.), Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Rinku Sutradhar
- ICES (S.J.B., R.K., L.P., A.S.G.), Toronto, ON, Canada; Sunnybrook Research Institute (S.J.B., A.V.L., R.S., L.P., A.S.G.), Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Dalla Lana School of Public Health (R.S.), University of Toronto, Toronto, ON, Canada
| | - Lawrence Paszat
- ICES (S.J.B., R.K., L.P., A.S.G.), Toronto, ON, Canada; Sunnybrook Research Institute (S.J.B., A.V.L., R.S., L.P., A.S.G.), Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Institute of Health Policy (L.P., ASG), Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Dina Brooks
- School of Rehabilitation Sciences (D.B.), McMaster University, Hamilton, ON, Canada
| | - Andrea S Gershon
- Institute of Medical Sciences (S.J.B., A.S.G.), University of Toronto, Toronto, ON, Canada; ICES (S.J.B., R.K., L.P., A.S.G.), Toronto, ON, Canada; Sunnybrook Research Institute (S.J.B., A.V.L., R.S., L.P., A.S.G.), Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Institute of Health Policy (L.P., ASG), Management and Evaluation, University of Toronto, Toronto, ON, Canada.
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Butler SJ, Louie AV, Sutradhar R, Paszat L, Brooks D, Gershon AS. Association between COPD and Stage of Lung Cancer Diagnosis: A Population-Based Study. Curr Oncol 2023; 30:6397-6410. [PMID: 37504331 PMCID: PMC10377848 DOI: 10.3390/curroncol30070471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/26/2023] [Accepted: 07/01/2023] [Indexed: 07/29/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is associated with an increased risk of lung cancer; however, the association between COPD and stage of lung cancer diagnosis is unclear. We conducted a population-based cross-sectional analysis of lung cancer patients (2008-2020) in Ontario, Canada. Using estimated propensity scores and inverse probability weighting, logistic regression models were developed to assess the association between COPD and lung cancer stage at diagnosis (early: I/II, advanced: III/IV), accounting for prior chest imaging. We further examined associations in subgroups with previously diagnosed and undiagnosed COPD. Over half (55%) of all lung cancer patients in Ontario had coexisting COPD (previously diagnosed: 45%, undiagnosed at time of cancer diagnosis: 10%). Compared to people without COPD, people with COPD had 30% lower odds of being diagnosed with lung cancer in the advanced stages (OR = 0.70, 95% CI: 0.68 to 0.72). Prior chest imaging only slightly attenuated this association (OR = 0.77, 95% CI: 0.75 to 0.80). The association with lower odds of advanced-stage diagnosis remained, regardless of whether COPD was previously diagnosed (OR = 0.68, 95% CI: 0.66 to 0.70) or undiagnosed (OR = 0.77, 95% CI: 0.73 to 0.82). Although most lung cancers are detected in the advanced stages, underlying COPD was associated with early-stage detection. Lung cancer diagnostics may benefit from enhanced partnership with COPD healthcare providers.
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Affiliation(s)
- Stacey J Butler
- Institute of Medical Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada
- ICES, Toronto, ON M4N 3M5, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Alexander V Louie
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Rinku Sutradhar
- ICES, Toronto, ON M4N 3M5, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Lawrence Paszat
- ICES, Toronto, ON M4N 3M5, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
| | - Dina Brooks
- School of Rehabilitation Sciences, McMaster University, Hamilton, ON L8S 1C7, Canada
| | - Andrea S Gershon
- Institute of Medical Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada
- ICES, Toronto, ON M4N 3M5, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
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Michaux KD, Metcalfe RK, Burns P, Conklin AI, Hoens AM, Smith D, Struik L, Safari A, Sin DD, Sadatsafavi M. IMplementing Predictive Analytics towards efficient COPD Treatments (IMPACT): protocol for a stepped-wedge cluster randomized impact study. Diagn Progn Res 2023; 7:3. [PMID: 36782301 PMCID: PMC9926816 DOI: 10.1186/s41512-023-00140-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 01/09/2023] [Indexed: 02/15/2023] Open
Abstract
INTRODUCTION Personalized disease management informed by quantitative risk prediction has the potential to improve patient care and outcomes. The integration of risk prediction into clinical workflow should be informed by the experiences and preferences of stakeholders, and the impact of such integration should be evaluated in prospective comparative studies. The objectives of the IMplementing Predictive Analytics towards efficient chronic obstructive pulmonary disease (COPD) treatments (IMPACT) study are to integrate an exacerbation risk prediction tool into routine care and to determine its impact on prescription appropriateness (primary outcome), medication adherence, quality of life, exacerbation rates, and sex and gender disparities in COPD care (secondary outcomes). METHODS IMPACT will be conducted in two phases. Phase 1 will include the systematic and user-centered development of two decision support tools: (1) a decision tool for pulmonologists called the ACCEPT decision intervention (ADI), which combines risk prediction from the previously developed Acute COPD Exacerbation Prediction Tool with treatment algorithms recommended by the Canadian Thoracic Society's COPD pharmacotherapy guidelines, and (2) an information pamphlet for COPD patients (patient tool), tailored to their prescribed medication, clinical needs, and lung function. In phase 2, we will conduct a stepped-wedge cluster randomized controlled trial in two outpatient respiratory clinics to evaluate the impact of the decision support tools on quality of care and patient outcomes. Clusters will be practicing pulmonologists (n ≥ 24), who will progressively switch to the intervention over 18 months. At the end of the study, a qualitative process evaluation will be carried out to determine the barriers and enablers of uptake of the tools. DISCUSSION The IMPACT study coincides with a planned harmonization of electronic health record systems across tertiary care centers in British Columbia, Canada. The harmonization of these systems combined with IMPACT's implementation-oriented design and partnership with stakeholders will facilitate integration of the tools into routine care, if the results of the proposed study reveal positive association with improvement in the process and outcomes of clinical care. The process evaluation at the end of the trial will inform subsequent design iterations before largescale implementation. TRIAL REGISTRATION NCT05309356.
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Affiliation(s)
- Kristina D Michaux
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Rebecca K Metcalfe
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, V6T 1Z3, Canada
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Paloma Burns
- Centre for Heart Lung Innovation, University of British Columbia & St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Annalijn I Conklin
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, V6T 1Z3, Canada
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Alison M Hoens
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), St. Paul's Hospital, Vancouver, British Columbia, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Laura Struik
- School of Nursing, University of British Columbia, Kelowna, BC, Canada
| | - Abdollah Safari
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, V6T 1Z3, Canada
- Department of Mathematics, Statistics, and Computer Science, University of Tehran, Tehran, Iran
| | - Don D Sin
- Centre for Heart Lung Innovation, University of British Columbia & St. Paul's Hospital, Vancouver, British Columbia, Canada
- Department of Medicine (Division of Respirology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Mohsen Sadatsafavi
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, V6T 1Z3, Canada.
- Department of Medicine (Division of Respirology), University of British Columbia, Vancouver, British Columbia, Canada.
- Centre for Clinical Epidemiology and Evaluation, University of British Columbia, Vancouver, British Columbia, Canada.
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Flor-Escriche X, Sanz Bas A, Álvarez Álvarez S, Zamora Putin V, Monteagudo Zaragoza M. Riesgos, fenotipos y comparación de tratamiento de EPOC en atención primaria según guías GOLD y GesEPOC. Semergen 2022; 48:101839. [DOI: 10.1016/j.semerg.2022.101839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/22/2022] [Accepted: 09/02/2022] [Indexed: 11/22/2022]
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10
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Tranmer J, Rotter T, O'Donnell D, Marciniuk D, Green M, Kinsman L, Li W. Determining the influence of the primary and specialist network of care on patient and system outcomes among patients with a new diagnosis of chronic obstructive pulmonary disease (COPD). BMC Health Serv Res 2022; 22:1210. [PMID: 36171574 PMCID: PMC9520829 DOI: 10.1186/s12913-022-08588-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Care for patients with chronic obstructive pulmonary disease (COPD) is provided by both family physicians (FP) and specialists. Ideally, patients receive comprehensive and coordinated care from this provider team. The objectives for this study were: 1) to describe the family and specialist physician network of care for Ontario patients newly diagnosed with COPD and 2) to determine the associations between selected characteristics of the physician network and unplanned healthcare utilization. Methods We conducted a retrospective cohort study using Ontario health administrative data housed at ICES (formerly the Institute for Clinical Evaluative Sciences). Ontario patients, ≥ 35 years, newly diagnosed with COPD were identified between 2005 and 2013. The FP and specialist network of care characteristics were described, and the relationship between selected characteristics (i.e., continuity of care) with unplanned healthcare utilization during the first 5 years after COPD diagnosis were determined in multivariate models. Results Our cohort consisted of 450,837 patients, mean age 61.5 (SD 14.6) years. The FP was the predominant provider of care for 86.4% of the patients. Using the Bice-Boxerman’s Continuity of Care Index (COCI), a measure reflecting care across different providers, 227,082 (50.4%) were categorized in a low COCI group based on a median cut-off. In adjusted analyses, patients in the low COCI group were more likely to have a hospital admission (OR = 2.27, 95% CI 2.20,2.22), 30-day readmission (OR = 2.44, 95% CI 2.39, 2.49) and ER visit (OR = 2.27, 95% CI 2.25, 2.29). Conclusion Higher indices of continuity of care are associated with reduced unplanned hospital use for patients with COPD. Primary care-based practice models to enhance continuity through coordination and integration of both primary and specialist care have the potential to enhance the health experience for patients with COPD and should be a health service planning priority.
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Affiliation(s)
- J Tranmer
- From the Department of Medicine, Family Medicine and Nursing ICES-Queen's and Queen's Health Services Policy Research Institute Queen's Health Sciences, Queen's University, Kingston, Canada.
| | - T Rotter
- From the Department of Medicine, Family Medicine and Nursing ICES-Queen's and Queen's Health Services Policy Research Institute Queen's Health Sciences, Queen's University, Kingston, Canada
| | - D O'Donnell
- From the Department of Medicine, Family Medicine and Nursing ICES-Queen's and Queen's Health Services Policy Research Institute Queen's Health Sciences, Queen's University, Kingston, Canada
| | - D Marciniuk
- Respiratory Research Center, University of Saskatchewan, Saskatoon, Canada
| | - M Green
- From the Department of Medicine, Family Medicine and Nursing ICES-Queen's and Queen's Health Services Policy Research Institute Queen's Health Sciences, Queen's University, Kingston, Canada
| | - L Kinsman
- School of Evidence Based Nursing, University of New Castle, New Castle, Australia
| | - W Li
- From the Department of Medicine, Family Medicine and Nursing ICES-Queen's and Queen's Health Services Policy Research Institute Queen's Health Sciences, Queen's University, Kingston, Canada
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11
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Izquierdo JL, Rodríguez JM, Almonacid C, Benavent M, Arroyo-Espliguero R, Agustí A. Real-life burden of hospitalizations due to COPD exacerbations in Spain. ERJ Open Res 2022; 8:00141-2022. [PMID: 35983537 PMCID: PMC9379352 DOI: 10.1183/23120541.00141-2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/06/2022] [Indexed: 11/05/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) often suffer episodes of exacerbation of symptoms (ECOPD) that may eventually require hospitalization due to several, often overlapping, causes. We aimed to analyse the characteristics of patients hospitalized because of ECOPD in a real-life setting using a big-data approach. The study population included all patients older than 40 years with a diagnosis of COPD (n=69.359; prevalence 3.72%) registered since January 1st, 2011, until March 1, 2020, in the database of the public healthcare service (SESCAM) of Castilla-La Mancha (Spain) (n=1.863.759 subjects). We used natural language processing (Savana Manager v3.0) to identify those who were hospitalized during this period for any cause, including ECOPD. During the study 26.453 COPD patients (38.1%) were hospitalized (at least once). Main diagnoses at discharge were respiratory infection (51%), heart failure (38%) or pneumonia (19%). ECOPD was the main diagnosis at discharge (or hospital death) in 8.331 of them (12.0% of the entire COPD population and 31.5% of those hospitalized). In-hospital ECOPD-related mortality rate was 3.1%. These patients were hospitalized 2.36 times per patient, with a mean hospital stay of 6.1 days. Heart failure (HF) was the most frequent comorbidity in patients hospitalized because of ECOPD (52.6%). This analysis shows that, in a real-life setting, ECOPD hospitalizations are prevalent, complex (particularly in relation to HF), repetitive and associated with significant in-hospital mortality.
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12
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Luis Izquierdo J, Casanova C, Celli B, Santos S, Sibila O, Sobradillo P, Agusti A. The 7 cardinal sins of COPD in Spain. Arch Bronconeumol 2022; 58:498-503. [DOI: 10.1016/j.arbres.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 11/26/2022]
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13
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Hussey AJ, Wing K, Ferrone M, Licskai CJ. Integrated Disease Management for Chronic Obstructive Pulmonary Disease in Primary Care, from the Controlled Trial to Clinical Program: A Cohort Study. Int J Chron Obstruct Pulmon Dis 2021; 16:3449-3464. [PMID: 35221683 PMCID: PMC8866979 DOI: 10.2147/copd.s338851] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/06/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Anna J Hussey
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada
| | - Kevin Wing
- London School of Hygiene and Tropical Medicine, London, UK
| | - Madonna Ferrone
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada
- Hotel-Dieu Grace Healthcare, Windsor, ON, Canada
| | - Christopher J Licskai
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada
- London Health Sciences Centre, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Correspondence: Christopher J Licskai Schulich School of Medicine and Dentistry, Western University, London, ON, Canada Email
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14
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Hussey AJ, Sibbald SL, Ferrone M, Hergott A, McKelvie R, Faulds C, Roberts Z, Scarffe AD, Meyer MJ, Vollbrecht S, Licskai C. Confronting complexity and supporting transformation through health systems mapping: a case study. BMC Health Serv Res 2021; 21:1146. [PMID: 34688279 PMCID: PMC8540206 DOI: 10.1186/s12913-021-07168-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/11/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Health systems are a complex web of interacting and interconnected parts; introducing an intervention, or the allocation of resources, in one sector can have effects across other sectors and impact the entire system. A prerequisite for effective health system reorganisation or transformation is a broad and common understanding of the current system amongst stakeholders and innovators. Chronic obstructive pulmonary disease (COPD) and heart failure (HF) are common chronic diseases with high health care costs that require an integrated health system to effectively treat. STUDY DESCRIPTION This case study documents the first phase of system transformation at a regional level in Ontario, Canada. In this first phase, visual representations of the health system in its current state were developed using a collaborative co-creation approach, and a focus on COPD and HF. Multiple methods were used including focus groups, open-ended questionnaires, and document review, to develop a series of graphical and visual representations; a health care ecosystem map. RESULTS The ecosystem map identified key sectoral components, inter-component interactions, and care requirements for patients with COPD and HF and inventoried current programs and services available to deliver this care. Main findings identified that independent system-wide navigation for this vulnerable patient group is limited, primary care is central to the accessibility of nearly half of the identified care elements, and resources are not equitably distributed. The health care ecosystem mapping helped to identify care gaps and illustrates the need to resource the primary care provider and the patient with system navigation resources and interdisciplinary team care. CONCLUSION The co-created health care ecosystem map brought a collective understanding of the health care system as it applies to COPD and HF. The map provides a blueprint that can be adapted to other disease states and health systems. Future transformation will build on this foundational work, continuing the robust interdisciplinary co-creation strategies, exploring predictive health system modelling and identifying areas for integration.
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Affiliation(s)
- Anna J Hussey
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada
| | - Shannon L Sibbald
- Faculty of Health Sciences, Western University, London, ON, Canada
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Madonna Ferrone
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada
- Hotel-Dieu Grace Healthcare, Windsor, ON, Canada
| | - Alyson Hergott
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada
| | - Robert McKelvie
- St. Joseph's Health Care, London, ON, Canada
- Cardiology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Cathy Faulds
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- St. Joseph's Health Care, London, ON, Canada
| | - Zofe Roberts
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada
| | - Andrew D Scarffe
- Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
| | - Matthew J Meyer
- London Health Sciences Centre, London, ON, Canada
- Department of Epidemiology and Biostatistics and Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Ivey Business School, London, ON, Canada
| | | | - Christopher Licskai
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada.
- London Health Sciences Centre, London, ON, Canada.
- Lawson Health Research Institute, London, ON, Canada.
- Respirology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
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15
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Patterns of Pulmonary Consultation for Veterans with Incident Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2021; 18:1249-1252. [PMID: 33794140 DOI: 10.1513/annalsats.202008-1075rl] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kimball BK, Tutalo RA, Minami T, Eaton CB. Evaluating an integrated chronic obstructive pulmonary disease management program implemented in a primary care setting. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Brianna K. Kimball
- Pharmacy Services Rhode Island Primary Care Physicians Corporation Cranston Rhode Island USA
| | - Ronald A. Tutalo
- Pharmacy Services Rhode Island Primary Care Physicians Corporation Cranston Rhode Island USA
| | - Taro Minami
- Department of Medicine The Warren Alpert Medical School of Brown University Providence Rhode Island USA
- Division of Pulmonary and Sleep Medicine Care New England Medical Group Providence Rhode Island USA
| | - Charles B. Eaton
- Department of Family Medicine The Warren Alpert Medical School of Brown University Providence Rhode Island USA
- Department of Epidemiology School of Public Health of Brown University Providence Rhode Island USA
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Rayner J, Khan T, Chan C, Wu C. Illustrating the patient journey through the care continuum: Leveraging structured primary care electronic medical record (EMR) data in Ontario, Canada using chronic obstructive pulmonary disease as a case study. Int J Med Inform 2020; 140:104159. [DOI: 10.1016/j.ijmedinf.2020.104159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 03/06/2020] [Accepted: 04/23/2020] [Indexed: 12/25/2022]
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18
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Williams MT, Johnston KN, Paquet C. Cognitive Behavioral Therapy for People with Chronic Obstructive Pulmonary Disease: Rapid Review. Int J Chron Obstruct Pulmon Dis 2020; 15:903-919. [PMID: 32425516 PMCID: PMC7186773 DOI: 10.2147/copd.s178049] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 02/21/2020] [Indexed: 12/30/2022] Open
Abstract
Cognitive behavioral therapy (CBT) is increasingly recommended in the management of people living with chronic obstructive pulmonary disease (COPD). This rapid review presents the evidence base for CBT for people with COPD and describes 1) the nature of CBT interventions and comparators in controlled trials (high or low resource intensity); and 2) factors influencing intervention effects on health outcomes (anxiety, depression, breathlessness, quality of life and exercise capacity). Primary studies reporting CBT interventions in adults with COPD were identified with data extracted by a single reviewer (20% of studies checked for data accuracy). Studies were synthesized descriptively with meta-analyses (random effects models) of controlled trials undertaken to report mean standardized effect sizes (95% CI) for health outcomes. Random effects meta-regression models explored whether CBT target, intervention dosage, intensity, facilitator profession, delivery mode, clinically significant anxiety/depression, trial design/quality and sample size predicted effect size. The search identified 33 primary studies published between 1996 and 2019 (controlled trials n=24, single group cohort n=6, case exemplars n=2, phenomenological n=1). Controlled trials frequently compared high-intensity CBT interventions against enhanced/usual care (n=12) or high-intensity CBT interventions against high-intensity comparators (n=11). When all controlled studies were included, small, significant improvements favoring CBT were evident across all health outcomes (SMD ranged from -0.27 to 0.35, p<0.05). When intensity dyads were considered, significant improvements were evident only when high-intensity CBT interventions were compared to enhanced usual care/usual care (SMDs ranged from -0.45 to 0.54, p <0.05). No other variable consistently predicted intervention effect sizes across all health outcomes. Overall, the evidence base supports the use of CBT for a range of health outcomes in people with COPD. Consistent benefits were evident when high-resource-intensive CBT interventions were compared to usual care. Low-resource-intensity CBT warrants further investigation in settings where cost of comprehensive care is prohibitive.
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Affiliation(s)
- Marie T Williams
- Innovation, Implementation and Clinical Translation in Health (IIMPACT), School of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
| | - Kylie N Johnston
- Innovation, Implementation and Clinical Translation in Health (IIMPACT), School of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
| | - Catherine Paquet
- Australian Centre of Precision Health, School of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
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Izquierdo JL, Morena D, González Y, Paredero JM, Pérez B, Graziani D, Gutiérrez M, Rodríguez JM. Clinical Management of COPD in a Real-World Setting. A Big Data Analysis. Arch Bronconeumol 2020; 57:94-100. [PMID: 32098727 DOI: 10.1016/j.arbres.2019.12.025] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 12/17/2019] [Accepted: 12/21/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the quality of diagnosis and treatment of COPD using Big Data methodology on the Savana Manager 2.1 clinical platform. MATERIALS AND METHODS A total of 59,369 patients with a diagnosis of COPD were included from a population of 1,219,749 adults over 40 years of age. RESULTS In total, 78% were men. Spirometry data were available for only 26,453 (43.5%) subjects. Disease severity was classified in 18,172 patients: 4,396 mild, 7,100 moderate, and 6,676 severe, although only 27%, 34%, and 28%, respectively, presented obstructive spirometry. The clinical management of COPD is mainly the responsibility of the primary care and pulmonology departments, while internal medicine and, to a lesser extent, geriatrics also participate. Drug treatment was based on bronchodilators and inhaled corticosteroids (ICS). A marked decline in the use of long-acting beta-2 agonists (LABA) in monotherapy and a slight reduction in ICS/LABA combinations, associated with a LAMA in 74% of cases, was observed. All-cause in-hospital mortality among the overall population was 5.6% compared to 1% of the general population older than 40 years. In total, 35% were admitted to hospital, with an average stay of 6.6 days and a rate of hospital mortality in this group of 10.74%. DISCUSSION This study identifies the main features of an unselected COPD population and the major errors made in the management of the disease.
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Affiliation(s)
- José Luis Izquierdo
- Departamento de Medicina y Especialidades, Universidad de Alcalá, Madrid, España; Servicio de Neumología, Hospital Universitario de Guadalajara, Guadalajara, España.
| | - Diego Morena
- Servicio de Neumología, Hospital Universitario de Guadalajara, Guadalajara, España
| | | | - José Manuel Paredero
- Servicio de Farmacia de Atención Primaria, GAI de Guadalajara, Guadalajara, España
| | - Bernardino Pérez
- Servicio de Informática, Hospital Universitario de Guadalajara, Guadalajara, España
| | - Desirée Graziani
- Servicio de Neumología, Hospital Universitario de Guadalajara, Guadalajara, España
| | - Matilde Gutiérrez
- Servicio de Contratación Administrativa, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - José Miguel Rodríguez
- Departamento de Medicina y Especialidades, Universidad de Alcalá, Madrid, España; Servicio de Neumología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
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Donovan LM, Shah A, Chai-Coetzer CL, Barbé F, Ayas NT, Kapur VK. Redesigning Care for OSA. Chest 2019; 157:966-976. [PMID: 31639334 DOI: 10.1016/j.chest.2019.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 09/09/2019] [Accepted: 10/01/2019] [Indexed: 02/07/2023] Open
Abstract
Constrained by a limited supply of specialized personnel, health systems face a challenge in caring for the large number of patients with OSA. The complexity of this challenge is heightened by the varied clinical presentations of OSA and the diversity of treatment approaches. Innovations such as simplified home-based care models and the incorporation of nonspecialist providers have shown promise in the management of uncomplicated patients, producing comparable outcomes to the resource-intensive traditional approach. However, it is unclear if these innovations can meet the needs of all patients with OSA, including those with mild disease, atypical presentations, and certain comorbid medical and mental health conditions. This review discusses the diversity of needs in OSA care, the evidence base behind recent care innovations, and the potential limitations of each innovation in meeting the diversity of care needs. We propose how these innovations can fit within the stepped care and hub and spoke models in a way that addresses the full spectrum of OSA, and we discuss future research directions to assess the deployment of these innovations.
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Affiliation(s)
- Lucas M Donovan
- HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA; University of Washington School of Medicine, Seattle, WA
| | - Aditi Shah
- Leon Judah Blackmore Sleep Disorders Program, University of British Columbia, Vancouver, BC, Canada
| | - Ching Li Chai-Coetzer
- Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia; Respiratory and Sleep Service, Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - Ferran Barbé
- Institut de Recerca Biomèdica of Lleida and CIBERES, Lleida, Catalonia, Spain
| | - Najib T Ayas
- Leon Judah Blackmore Sleep Disorders Program, University of British Columbia, Vancouver, BC, Canada
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