scholarly journals Burden and impact of chronic cough in UK primary care: a dataset analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e054832
Author(s):  
James H Hull ◽  
Haya Langerman ◽  
Zia Ul-Haq ◽  
Tahereh Kamalati ◽  
Amanda Lucas ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Cough ◽  
Index Date ◽  
Healthcare Utilisation ◽  
Chronic Obstructive ◽  
Service Utilisation ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease ◽  
North West ◽  
Before And After

ObjectiveChronic cough (CC) is a debilitating respiratory symptom, now increasingly recognised as a discrete disease entity. This study evaluated the burden of CC in a primary care setting.DesignCross-sectional, retrospective cohort study.SettingDiscover dataset from North West London, which links coded data from primary and secondary care. The index date depicted CC persisting for ≥8 weeks and was taken as a surrogate for date of CC diagnosis.ParticipantsData were extracted for individuals aged ≥18 years with a cough persisting ≥8 weeks or cough remedy prescription, between Jan 2015 and Sep 2019.Main outcome measuresDemographic characteristics, comorbidities and service utilisation cost, including investigations performed and treatments prescribed were determined.ResultsCC was identified in 43 453 patients from a total cohort of 2 109 430 (2%). Median (IQR) age was 64 years (41–87). Among the cohort, 31% had no recorded comorbidities, 26% had been given a diagnosis of asthma, 17% chronic obstructive pulmonary disease, 12% rhinitis and 15% reflux. Prevalence of CC was greater in women (57%) and highest in the 65–74 year age range. There was an increase in the number of all investigations performed in the 12 months before and after the index date of CC diagnosis, and in particular for primary care chest X-ray and spirometry which increased from 6535 to 12 880 and from 5791 to 8720, respectively. This was accompanied by an increase in CC-associated healthcare utilisation costs.ConclusionOne-third of individuals had CC in the absence of associated comorbidities, highlighting the importance of recognising CC as a condition in its own right. Overall outpatient costs increased in the year after the CC index date for all comorbidities, but varied significantly with age. Linked primary-care datasets may enable earlier detection of individuals with CC for specialist clinic referral and targeted treatment.

scholarly journals Chronic obstructive pulmonary disease and comorbidities: a large cross-sectional study in primary care

2017 ◽  
Vol 67 (658) ◽  
pp. e321-e328 ◽  
Author(s):  
Ula Chetty ◽  
Gary McLean ◽  
Deborah Morrison ◽  
Karolina Agur ◽  
Bruce Guthrie ◽  
...  
Keyword(s):  
Mental Health ◽  
Chronic Obstructive Pulmonary Disease ◽  
Primary Care ◽  
Pulmonary Disease ◽  
Integrated Approach ◽  
Chronic Obstructive ◽  
Physical And Mental Health ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease ◽  
Health Comorbidities

BackgroundChronic obstructive pulmonary disease (COPD) is common, and a major cause of morbidity and mortality worldwide. Recent studies suggest that comorbidities of COPD increase the risk of hospitalisation, polypharmacy, and mortality, but their estimated prevalence varies widely in the literature.AimTo evaluate the prevalence of 38 physical and mental health comorbidities in people with COPD, and compare findings with those for people without COPD in a large nationally representative dataset.Design and settingA cross-sectional data analysis on 1 272 685 adults in Scotland from 314 primary care practices.MethodData on COPD, along with 31 physical and seven mental health comorbidities, were extracted. The prevalence of comorbidities was compared between people who did, and did not, have COPD, standardised by age, sex, and socioeconomic deprivation.ResultsFrom the total sample, 51 928 patients had COPD (4.1%). Of these, 86.0% had at least one comorbidity, compared with 48.9% of people without COPD. Of those with COPD, 22.3% had ≥5 comorbid conditions compared with 4.9% of those who did not have COPD (adjusted odds ratio 2.63, 95% confidence interval = 2.56 to 2.70). In total, 29 of the 31 physical conditions and six of the seven mental health conditions were statistically significantly more prevalent in people who had COPD than those who did not.ConclusionPatients with COPD have extensive associated comorbidities. There is a real need for guidelines and health care to reflect this complexity, including how to detect those common comorbidities that relate to both physical and mental health, and how best to manage them. Primary care, which is unique in terms of offering expert generalist care, is best placed to provide this integrated approach.

scholarly journals Phenotypic Variation in Patients with Chronic Obstructive Pulmonary Disease in Primary Care

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Emmylou Beekman ◽  
Ilse Mesters ◽  
Mark G. Spigt ◽  
Eva A. M. van Eerd ◽  
Rik Gosselink ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Status ◽  
Airway Obstruction ◽  
Physical Therapist ◽  
Patient Characteristics ◽  
Cross Sectional Study ◽  
Chronic Obstructive ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease ◽  
Phenotypic Differences

Introduction. Despite the high number of inactive patients with COPD, not all inactive patients are referred to physical therapy, unlike recommendations of general practitioner (GP) guidelines. It is likely that GPs take other factors into account, determining a subpopulation that is treated by a physical therapist (PT). The aim of this study is to explore the phenotypic differences between inactive patients treated in GP practice and inactive patients treated in GP practice combined with PT. Additionally this study provides an overview of the phenotype of patients with COPD in PT practice.Methods. In a cross-sectional study, COPD patient characteristics were extracted from questionnaires. Differences regarding perceived health status, degree of airway obstruction, exacerbation frequency, and comorbidity were studied in a subgroup of 290 inactive patients and in all 438 patients.Results. Patients treated in GP practice combined with PT reported higher degree of airway obstruction, more exacerbations, more vascular comorbidity, and lower health status compared to patients who were not referred to and treated by a PT.Conclusion. Unequal patient phenotypes in different primary care settings have important clinical implications. It can be carefully concluded that other factors, besides the level of inactivity, play a role in referral to PT.

scholarly journals Clinico-epidemiological characteristics of men and women with a new diagnosis of chronic obstructive pulmonary disease: a database (SIDIAP) study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Josep Montserrat-Capdevila ◽  
Josep Ramon Marsal ◽  
Marta Ortega ◽  
Maria Teresa Castañ-Abad ◽  
Miquel Alsedà ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Primary Care ◽  
Pulmonary Disease ◽  
Cor Pulmonale ◽  
Chronic Obstructive ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease ◽  
Men And Women ◽  
Epidemiological Characteristics ◽  
Strength Of Association

Abstract Background The risk of developing Chronic Obstructive Pulmonary Disease (COPD), the associated comorbidities and response to bronchodilators might differ in men and women. The objective of this study was to determine the prevalence of COPD and the clinic-epidemiological characteristics of primary care patients with COPD according to gender. Methods This is a cross-sectional study using electronic healthcare records Catalonia (Spain), during the 01/01/2012–31/12/2017 period. Patients from the SIDIAP database (System for the Development of Research in Primary Care) were included (5,800,000 patients registered in 279 primary care health centres). Clinic-demographic characteristics, comorbidities and blood tests results were collected for each patient. Adjusted OR (ORa) with logistic regression methods were used to determine variables associated with men and women. Results From an initial sample of 800,899 people, 24,135 (3%) were considered COPD patients, and 22.9%were women. The most common risk factors in women were bronchiectasis (ORa = 20.5, SD = 19.5–21.6), age > 71 years (ORa = 18.8; SD = 17.3–20.5), cor pulmonale (ORa = 5.2; SD = 4.3–6.7) and lung cancer (ORa = 3.6, SD = 3.2–4.0). Men and women presented the same comorbidities, though the strength of association was different for each gender. Conclusions Patients suffering high comorbidity rates. Comorbidities are similar in men and women, although the strength of association varies according to gender. Women are more susceptible to the harmful effects of smoking and present a higher proportion of bronchiectasis and OSAS.

scholarly journals Medicare-related service use and costs among people with diagnosed and undiagnosed diabetes and respiratory conditions

2009 ◽  
Vol 33 (1) ◽  
pp. 107 ◽  
Author(s):  
Catherine R Chittleborough ◽  
Michael J Burke ◽  
Anne W Taylor ◽  
David H Wilson ◽  
Patrick J Phillips ◽  
...  
Keyword(s):  
Service Use ◽  
Cost Benefit ◽  
Cross Sectional Study ◽  
Self Report ◽  
Undiagnosed Diabetes ◽  
Chronic Obstructive ◽  
Service Utilisation ◽  
Cross Sectional ◽  
North West ◽  
The North

Objective: To compare Medicare-related costs and service utilisation of people with diagnosed diabetes, asthma or chronic obstructive pulmonary disease (COPD) to those who were previously undiagnosed, and those without these conditions. Design, setting and participants: Representative cross-sectional study of people (18+ years) living in the north-west area of Adelaide. Participants were recruited by telephone interviews. Biomedical and self-report data for 2352 participants were linked to Medicare Australia Medicare Benefits Schedule (MBS) data from 1997 to 2002. Main outcome measures: Mean number and cost (benefit paid) of MBS services for people with diagnosed and previously undiagnosed diabetes, asthma, and COPD, and those without these conditions. Results: Mean (�SD) MBS costs were significantly greater for people diagnosed with diabetes ($4205 �2596), asthma ($3307 �2542), or COPD ($3779 �2529) than for those without these conditions. MBS costs for people with asthma or COPD that had not yet been diagnosed were also significantly higher than for those without these conditions, although this was inconsistent across financial years. Conclusions: Diabetes, asthma, and COPD are costly conditions in terms of health service use. Costs associated with undiagnosed asthma and COPD are similar to their diagnosed states. Prevention of progression along each chronic disease continuum is likely to reduce costs.

scholarly journals Recognising heart failure in elderly patients with stable chronic obstructive pulmonary disease in primary care: cross sectional diagnostic study

BMJ ◽  
2005 ◽  
Vol 331 (7529) ◽  
pp. 1379 ◽  
Author(s):  
Frans H Rutten ◽  
Karel G M Moons ◽  
Maarten-Jan M Cramer ◽  
Diederick E Grobbee ◽  
Nicolaas P A Zuithoff ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Obstructive Pulmonary Disease ◽  
Primary Care ◽  
Elderly Patients ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Diagnostic Study ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease

scholarly journals Prognostic value of first-recorded breathlessness for future chronic respiratory and heart disease: a cohort study using a UK national primary care database

2020 ◽  
Vol 70 (693) ◽  
pp. e264-e273 ◽  
Author(s):  
Ying Chen ◽  
Richard Hayward ◽  
Carolyn A Chew-Graham ◽  
Richard Hubbard ◽  
Peter Croft ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Heart Disease ◽  
Index Date ◽  
Early Mortality ◽  
Practice Research ◽  
Chronic Obstructive ◽  
Clinical Practice Research Datalink ◽  
Obstructive Pulmonary Disease

BackgroundBreathlessness is a common presentation in primary care.AimTo assess the long-term risk of diagnosed chronic obstructive pulmonary disease (COPD), asthma, ischaemic heart disease (IHD), and early mortality in patients with undiagnosed breathlessness.Design and settingMatched cohort study using data from the UK Clinical Practice Research Datalink.MethodAdults with first-recorded breathlessness between 1997 and 2010 and no prior diagnostic or prescription record for IHD or a respiratory disease (‘exposed’ cohort) were matched to individuals with no record of breathlessness (‘unexposed’ cohort). Analyses were adjusted for sociodemographic and comorbidity characteristics.ResultsIn total, 75 698 patients (the exposed cohort) were followed for a median of 6.1 years, and more than one-third subsequently received a diagnosis of COPD, asthma, or IHD. In those who remained undiagnosed after 6 months, there were increased long-term risks of all three diagnoses compared with those in the unexposed cohort. Adjusted hazard ratios for COPD ranged from 8.6 (95% confidence interval [CI] = 6.8 to 11.0) for >6–12 months after the index date to 2.8 (95% CI = 2.6 to 3.0) for >36 months after the index date; asthma, 11.7 (CI = 9.4 to 14.6) to 4.3 (CI = 3.9 to 4.6); and IHD, 3.0 (CI = 2.7 to 3.4) to 1.6 (CI = 1.5 to 1.7). Risk of a longer time to diagnosis remained higher in members of the exposed cohort who had no relevant prescription in the first 6 months; approximately half of all future diagnoses were made for such patients. Risk of early mortality (all cause and disease specific) was higher in members of the exposed cohort.ConclusionBreathlessness can be an indicator of developing COPD, asthma, and IHD, and is associated with early mortality. With careful assessment, appropriate intervention, and proactive follow-up and monitoring, there is the potential to improve identification at first presentation in primary care in those at high risk of future disease who present with this symptom.

Commissioning Processes in Primary Care Trusts: A Repeated Cross-Sectional Survey of Health Care Commissioners in England

2012 ◽  
Vol 17 (1_suppl) ◽  
pp. 31-39 ◽  
Author(s):  
Fiona Sampson ◽  
Alicia O'cathain ◽  
Mark Strong ◽  
Mark Pickin ◽  
Lisa Esmonde
Keyword(s):  
Primary Care ◽  
Urgent Care ◽  
Chronic Obstructive ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease ◽  
Telephone Surveys ◽  
The Public ◽  
And Performance ◽  
Clinical Engagement

Objectives To determine the extent to which primary care trusts (PCTs) in England employed processes associated with quality commissioning and to assess whether changes occurred in these processes during a policy drive to improve commissioning. Methods Telephone surveys of PCT managers leading commissioning for diabetes, chronic obstructive pulmonary disease (COPD), coronary heart disease (CHD), and emergency and urgent care in all 152 PCTs in both 2009 and 2010. Results The response rate was 51% (77/152) of PCTs in 2009 and 60% (91/152) in 2010. Two-thirds of commissioners had commissioned initiatives starting in the previous financial year. Over half of initiatives starting in 2008/09 had been instigated by the PCT alone. This reduced to a third in 2010, showing a shift towards partnership working. Commissioners reported that a large proportion of initiatives had been developed and shaped with the involvement of general practitioners (GPs) with direct links to the PCT and of specialist clinicians (70%), but that a lower proportion of initiatives had involvement from other GPs (40%). Patients or the public were less likely to be involved in initiatives than clinicians, but there was evidence of increasing involvement over the two years from 35% (52/149) to 51% (67/132) of initiatives. There was no evidence of changes in whether needs assessment was undertaken, how evidence was used or how initiatives were led and performance managed. Conclusions PCT commissioners reported clinical engagement in the majority of commissioning initiatives, a shift towards partnership commissioning, and increased involvement of patients and public in the development of initiatives. The new model of commissioning in England through clinical commissioning groups will need to improve on these processes if it is to demonstrate a higher quality approach to commissioning.

Sign in / Sign up

Export Citation Format

Share Document