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Pace WD, Brandt E, Carter VA, Chang KL, Edwards CL, Evans A, Fox C, Gaona G, Han MK, Kaplan AG, Kent R, Kocks JWH, Kruszyk M, Le Lievre CE, Li Voti T, Mahle C, Make B, Ratigan AR, Shaikh A, Skolnik N, Stanley B, Yawn BP, Price DB. COPD Population in US Primary Care: Data From the Optimum Patient Care DARTNet Research Database and the Advancing the Patient Experience in COPD Registry. Ann Fam Med 2022; 20:319-327. [PMID: 35879087 PMCID: PMC9328699 DOI: 10.1370/afm.2829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 12/13/2021] [Accepted: 01/06/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To describe demographic and clinical characteristics of chronic obstructive pulmonary disease patients managed in US primary care. METHODS This was an observational registry study using data from the Chronic Obstructive Pulmonary Disease (COPD) Optimum Patient Care DARTNet Research Database from which the Advancing the Patient Experience COPD registry is derived. Registry patients were aged ≥35 years at diagnosis. Electronic health record data were collected from both registries, supplemented with patient-reported information/outcomes from the Advancing the Patient Experience registry from 5 primary care groups in Texas, Ohio, Colorado, New York, and North Carolina (June 2019 through November 2020). RESULTS Of 17,192 patients included, 1,354 were also in the Advancing the Patient Experience registry. Patients were predominantly female (56%; 9,689/17,192), White (64%; 9,732/15,225), current/ex-smokers (80%; 13,784/17,192), and overweight/obese (69%; 11,628/16,849). The most commonly prescribed maintenance treatments were inhaled corticosteroid with a long-acting β2-agonist (30%) and inhaled corticosteroid with a long-acting muscarinic antagonist (27%). Although 3% (565/17,192) of patitents were untreated, 9% (1,587/17,192) were on short-acting bronchodilator monotherapy, and 4% (756/17,192) were on inhaled corticosteroid monotherapy. Despite treatment, 38% (6,579/17,192) of patients experienced 1 or more exacerbations in the last 12 months. These findings were mirrored in the Advancing Patient Experience registry with many patients reporting high or very high impact of disease on their health (43%; 580/1,322), a breathlessness score 2 or more (45%; 588/1,315), and 1 or more exacerbation in the last 12 months (50%; 646/1,294). CONCLUSIONS Our findings highlight the high exacerbation, symptom, and treatment burdens experienced by COPD patients managed in US primary care, and the need for more real-life effectiveness trials to support decision making at the primary care level.
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Affiliation(s)
- Wilson D Pace
- DARTNet Institute, Aurora, Colorado.,University of Colorado Denver, Denver, Colorado
| | | | | | - Ku-Lang Chang
- University of Florida College of Medicine, Gainesville, Florida
| | | | | | - Chester Fox
- DARTNet Institute, Aurora, Colorado.,University at Buffalo, Buffalo, New York
| | | | | | - Alan G Kaplan
- Observational & Pragmatic Research Institute, Singapore.,Family Physician Airways Group of Canada, Stouffville, Ontario, Canada.,University of Toronto, Toronto, Canada
| | | | - Janwillem W H Kocks
- Observational & Pragmatic Research Institute, Singapore.,General Practitioners Research Institute, Groningen, The Netherlands
| | | | | | | | - Cathy Mahle
- Boehringer Ingelheim, Ridgefield, Connecticut
| | - Barry Make
- Department of Medicine, National Jewish Health, Denver, Colorado
| | | | - Asif Shaikh
- Boehringer Ingelheim, Ridgefield, Connecticut
| | - Neil Skolnik
- Thomas Jefferson University, Woodbury, New Jersey.,Abington Jefferson Health, Jenkintown, Pennsylvania
| | - Brooklyn Stanley
- Optimum Patient Care, Cambridge, United Kingdom.,Observational & Pragmatic Research Institute, Singapore
| | - Barbara P Yawn
- University of Minnesota, Minneapolis, Minnesota.,COPD Foundation, Washington, DC
| | - David B Price
- Observational & Pragmatic Research Institute, Singapore; .,Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
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2
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Ehteshami-Afshar S, Crothers K, Rodwin B, Bade B, Brandt C, Akgün KM. Does pulmonary subspecialty referral from primary care affect the adherence to vaccination recommendations in COPD patients? Respir Res 2021; 22:50. [PMID: 33579277 PMCID: PMC7880521 DOI: 10.1186/s12931-021-01639-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/27/2021] [Indexed: 01/30/2023] Open
Abstract
The importance of vaccinations for COPD patients has been previously described. However, there is still a gap between guideline recommendations and the implementation of preventive care delivery for these patients. Specially, the rise of SARS-CoV-2 pandemic has made the significance of vaccination adherence more critical to address. Our study showed that referral to pulmonary clinic is associated with increased odds of receiving influenza (OR = 1.97, [95% CI 1.07, 3.65]) and pneumococcal vaccinations (PCV13 OR = 3.55, [1.47, 8.54]; PPSV23 OR = 4.92, [1.51, 16.02]). These data suggest that partnerships between primary care physicians and pulmonologists can potentially improve the vaccination rates for patients with COPD.
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Affiliation(s)
| | - Kristina Crothers
- Veterans Affairs Puget Sound and University of Washington, Seattle, WA, USA
| | - Benjamin Rodwin
- Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.,Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Brett Bade
- Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.,Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Cynthia Brandt
- Veterans Affairs Connecticut Pain Research, Informatics, Multi-Morbidities, and Education Center, West Haven, CT, USA.,Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Kathleen M Akgün
- Internal Medicine, Yale University School of Medicine, New Haven, CT, USA. .,Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA. .,Veterans Affairs Connecticut Pain Research, Informatics, Multi-Morbidities, and Education Center, West Haven, CT, USA.
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Ray E, Culliford D, Kruk H, Gillett K, North M, Astles CM, Hicks A, Johnson M, Lin SX, Orlando R, Thomas M, Jordan RE, Price D, Konstantin M, Wilkinson TMA. Specialist respiratory outreach: a case-finding initiative for identifying undiagnosed COPD in primary care. NPJ Prim Care Respir Med 2021; 31:7. [PMID: 33574260 PMCID: PMC7878732 DOI: 10.1038/s41533-021-00219-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 01/06/2021] [Indexed: 12/18/2022] Open
Abstract
COPD remains largely undiagnosed or is diagnosed late in the course of disease. We report findings of a specialist outreach programme to identify undiagnosed COPD in primary care. An electronic case-finding algorithm identified 1602 at-risk patients from 12 practices who were invited to attend the clinic. Three hundred and eighty-three (23.9%) responded and 288 were enrolled into the study. Forty-eight (16.6%) had undiagnosed mild and 28 (9.7%) had moderate airway obstruction, meeting spirometric diagnostic criteria for COPD. However, at 12 months only 8 suspected COPD patients (10.6%) had received a diagnostic label in their primary care record. This constituted 0.38% of the total patient population, as compared with 0.31% of control practices, p = 0.306. However, if all patients with airway obstruction received a coding of COPD, then the diagnosis rate in the intervention group would have risen by 0.84%. Despite the low take-up and diagnostic yield, this programme suggests that integrated case-finding strategies could improve COPD recognition.
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Affiliation(s)
- Emma Ray
- NIHR ARC Wessex, Faculty of Health Sciences, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - David Culliford
- NIHR ARC Wessex, Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Helen Kruk
- NIHR ARC Wessex, Faculty of Health Sciences, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Kate Gillett
- NIHR ARC Wessex, Faculty of Health Sciences, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mal North
- NIHR ARC Wessex, Faculty of Health Sciences, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Carla M Astles
- NIHR ARC Wessex, Faculty of Health Sciences, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Alexander Hicks
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Matthew Johnson
- NIHR ARC Wessex, Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Sharon Xiaowen Lin
- NIHR ARC Wessex, Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Rosanna Orlando
- NIHR ARC Wessex, Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Mike Thomas
- Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Rachel E Jordan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - David Price
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Mita Konstantin
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Tom M A Wilkinson
- Faculty of Medicine, University of Southampton, Southampton, UK.
- NIHR Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK.
- Wessex Investigational Sciences Hub, University of Southampton Faculty of Medicine, Southampton General Hospital, Southampton, UK.
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COVID-19 outpatients: early risk-stratified treatment with zinc plus low-dose hydroxychloroquine and azithromycin: a retrospective case series study. Int J Antimicrob Agents 2020; 56:106214. [PMID: 33122096 PMCID: PMC7587171 DOI: 10.1016/j.ijantimicag.2020.106214] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/13/2020] [Accepted: 10/20/2020] [Indexed: 02/07/2023]
Abstract
The aim of this study was to describe the outcomes of patients with coronavirus disease 2019 (COVID-19) in the outpatient setting after early treatment with zinc, low-dose hydroxychloroquine and azithromycin (triple therapy) dependent on risk stratification. This was a retrospective case series study in the general practice setting. A total of 141 COVID-19 patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the year 2020 were included. The main outcome measures were risk-stratified treatment decision and rates of hospitalisation and all-cause death. A median of 4 days [interquartile range (IQR) 3–6 days; available for n = 66/141 patients] after the onset of symptoms, 141 patients (median age 58 years, IQR 40–67 years; 73.0% male) received a prescription for triple therapy for 5 days. Independent public reference data from 377 confirmed COVID-19 patients in the same community were used as untreated controls. Of 141 treated patients, 4 (2.8%) were hospitalised, which was significantly fewer (P < 0.001) compared with 58 (15.4%) of 377 untreated patients [odds ratio (OR) = 0.16, 95% confidence interval (CI) 0.06–0.5]. One patient (0.7%) in the treatment group died versus 13 patients (3.4%) in the untreated group (OR = 0.2, 95% CI 0.03–1.5; P = 0.12). No cardiac side effects were observed. Risk stratification-based treatment of COVID-19 outpatients as early as possible after symptom onset using triple therapy, including the combination of zinc with low-dose hydroxychloroquine, was associated with significantly fewer hospitalisations.
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