Association between chronic comorbidity and exacerbation rate in primary care COPD patients. Preliminary analysis of real-life general practice data (PROSPECT1)

Abstract Background hospital discharge is a critical event for older patients. The French guidelines recommended the swift transmission of a discharge summary to the general practitioner (GP) and a primary care consultation within 7 days. The relevance and feasibility of these guidelines have not previously been assessed. Objective to perform a real-life assessment of compliance with French guidelines on the transmission of discharge summaries and post-discharge medical reviews and to examine these factors’ association with 30-day readmissions. Design a prospective multicentre cohort study. Setting primary care (general practice) in France. Subjects a sample of GPs and the same number of patients aged 75 or over having consulted within 30 days of hospital discharge. Methods the main endpoints were the proportion of discharge summaries available and the proportion of patients consulting their GP within 7 days. The 30-day readmission rate was also measured. Factors associated with these endpoints were assessed in univariate and multivariate analyses. Results seventy-one GPs (mean ± standard deviation age: 49 ± 11; males: 62%) and 71 patients (mean age: 84 ± 5; males: 52%; living at home: 94%; cognitive disorders: 22%) were included. Forty-six patients (65%, [95% confidence interval [CI]]: 53–76) consulted their GP within 7 days of hospital discharge. At the time of the consultation, 27 GPs (38% [95% CI]: 27–50) had not received the corresponding hospital discharge summary. Discharge summary availability was associated with a lower risk of 30-day readmission (adjusted odds ratio [95% CI] = 0.25 [0.07–0.91]). Conclusions compliance with the French guidelines on hospital-to-home transitions is insufficient.

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COPD patients prescribed inhaled corticosteroid in primary care: time for re-assessment based on exacerbation rate and blood eosinophils?

Respiratory Research ◽

10.1186/s12931-021-01651-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Osman Savran ◽

Nina Godtfredsen ◽

Torben Sørensen ◽

Christian Jensen ◽

Charlotte Suppli Ulrik

Keyword(s):

Primary Care ◽

Eosinophil Count ◽

Large Cohort ◽

Blood Eosinophil ◽

Study Cohort ◽

Inhaled Corticosteroid ◽

Exacerbation Rate ◽

Blood Eosinophil Count ◽

Copd Patients ◽

Blood Eosinophils

Abstract Background and objective Inhaled corticosteroid (ICS) therapy for COPD should be guided by exacerbations and blood-eosinophils according to the GOLD 2020 strategy document. In the present study, we applied these recent recommendations in a large cohort of COPD patients recruited from general practice. Methods The participating general practitioners (n = 144) recruited patients with a diagnosis of COPD currently prescribed ICS and reported data on exacerbation history and blood-eosinophils. Clinical variables were compared using two-sample t-tests. Results The study cohort comprised 1,567 COPD patients (44% males and mean age 72 years). In the past 12 months, 849 (54%) of the COPD patients currently prescribed ICS had no exacerbation, whereas 383 (24%) and 328 (21%) patients, respectively, had a history of one exacerbation and two or more exacerbations. Compared to patients with one or no exacerbation, patients with ≥ 2 exacerbations (21%) per year reported more dyspnea (p < 0.001) and had higher degree of airflow obstruction (p < 0.001). Among patients with no and at least one exacerbation within the preceding 12 months, 30% and 26%, respectively, had a blood-eosinophil count ≥ 0.3 × 109/L. In patients with two or more exacerbations within the last 12 months, 77% had a blood-eosinophil count of ≥ 0.1 × 109/L. Furthermore, 166 patients (11%) had at least one hospital admission due to COPD exacerbation, and a blood-eosinophil count of ≥ 0.1 × 109/L. Conclusion This study of a large cohort of COPD patients currently prescribed inhaled corticosteroids suggests the need for re-evaluating the management strategy to increase benefit and reduce adverse effects of ICS treatment in COPD patients managed in primary care.

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COPD patients prescribed inhaled corticosteroid in primary care – Time for re-assessment based on exacerbation rate and blood eosinophils?

10.21203/rs.3.rs-51349/v3 ◽

2021 ◽

Author(s):

Osman Savran ◽

Nina Skavlan Godtfredsen ◽

Torben Sørensen ◽

Christian Jensen ◽

Charlotte Ulrik

Keyword(s):

Primary Care ◽

Eosinophil Count ◽

Large Cohort ◽

Blood Eosinophil ◽

Study Cohort ◽

Inhaled Corticosteroid ◽

Exacerbation Rate ◽

Blood Eosinophil Count ◽

Copd Patients ◽

Blood Eosinophils

Abstract Background and objective: Inhaled corticosteroid (ICS) therapy for COPD should be guided by exacerbations and blood-eosinophils according to the GOLD 2020 strategy document. In the present study, we applied these recent recommendations in a large cohort of COPD patients recruited from general practice. Methods: The participating general practitioners (n = 144) recruited patients with a diagnosis of COPD currently prescribed ICS and reported data on exacerbation history and blood-eosinophils. Clinical variables were compared using two-sample t-tests. Results: The study cohort comprised 1,567 COPD patients (44% males and mean age 72 years). In the past 12 months, 849 (54%) of the COPD patients currently prescribed ICS had no exacerbation, whereas 383 (24%) and 328 (21%) patients, respectively, had a history of one exacerbation and two or more exacerbations. Compared to patients with one or no exacerbation, patients with ≥2 exacerbations (21%) per year reported more dyspnea (p<0.001) and had higher degree of airflow obstruction (p<0.001). Among patients with no and at least one exacerbation within the preceding 12 months, 30% and 26%, respectively, had a blood-eosinophil count ≥ 0.3 x 109/L. In patients with two or more exacerbations within the last 12 months, 77% had a blood-eosinophil count of ≥ 0.1 x 109/L. Furthermore, 166 patients (11%) had at least one hospital admission due to COPD exacerbation, and a blood-eosinophil count of ≥ 0.1 x 109/L.Conclusion: This study of a large cohort of COPD patients currently prescribed inhaled corticosteroids suggests the need for re-evaluating the management strategy to increase benefit and reduce adverse effects of ICS treatment in COPD patients managed in primary care.

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COPD patients prescribed inhaled corticosteroid in general practice: Based on disease characteristics according to guidelines?

Chronic Respiratory Disease ◽

10.1177/1479973119867949 ◽

2019 ◽

Vol 16 ◽

pp. 147997311986794 ◽

Cited By ~ 2

Author(s):

Osman Savran ◽

Nina Godtfredsen ◽

Torben Sørensen ◽

Christian Jensen ◽

Charlotte Suppli Ulrik

Keyword(s):

Primary Care ◽

General Practice ◽

Symptom Severity ◽

Airflow Limitation ◽

Disease Characteristics ◽

Copd Patients ◽

Co Morbidity ◽

Long Acting ◽

Blood Eosinophils ◽

Β2 Agonist

In a primary care setting, our aim was to investigate characteristics of patients classified as having chronic obstructive pulmonary disease (COPD) and currently being prescribed inhaled corticosteroids (ICSs). The electronic patient record system in each participating general practice was searched for patients coded as COPD (ICPC, Second Edition code R95) and treated with ICS (ACT code R03AK and R03BA, that is, ICS in combination with a long-acting β2-agonist) or ICS as monotherapy. Data, if available, on demographics, smoking habits, spirometry, COPD medication, symptom score, blood eosinophils, co-morbidity and exacerbation history were retrieved from the medical records for all identified cases. Of all patients registered in the 138 participating general practices, 12.560 (3%) were coded as COPD, of whom 32% were prescribed ICS. The final study sample comprised 2.289 COPD patients currently prescribed ICS (98% also prescribed long-acting β2-agonist), with 24% being coded as both COPD and asthma. Post-bronchodilator spirometry was available in 79% (mean forced expiratory volume in 1 second 60% pred (standard deviation (SD) 23.3)), symptom severity score in 53% (mean Medical Research Council score 2.7 (SD 1.1)) and 56% of the COPD patients had had no exacerbation in the previous year (and 45% not within the 2 previous years). Blood eosinophils were measured in 67% of the patients. Information on severity of airflow limitation was missing in 15% of the patients, and the combined information on symptom severity and exacerbation history was missing in in 46%. Most of the patients (74%) were managed only by their general practitioner. Although only one-third of the COPD patients were prescribed ICSs, our findings from this study of a large cohort of patients prescribed ICSs for COPD in general practice suggest that more detailed assessment of diagnosis and disease characteristics is likely to improve the risk–benefit ratio of maintenance therapy with ICSs in COPD patients managed in primary care.

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Variation in Demographic and Clinical Characteristics of COPD Patients Managed in U.S. Primary Care: Data from a Real-Life COPD Registry

10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2238 ◽

2021 ◽

Author(s):

W.D. Pace ◽

C. Edwards ◽

E. Brandt ◽

V. Carter ◽

K.-L. Chang ◽

...

Keyword(s):

Primary Care ◽

Clinical Characteristics ◽

Real Life ◽

Primary Care Data ◽

Copd Patients

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COPD patients prescribed inhaled corticosteroid in primary care – Time for re-assessment based on exacerbation rate and blood eosinophils?

10.21203/rs.3.rs-51349/v2 ◽

2020 ◽

Author(s):

Osman Savran ◽

Nina Skavlan Godtfredsen ◽

Torben Sørensen ◽

Christian Jensen ◽

Charlotte Ulrik

Keyword(s):

Primary Care ◽

Eosinophil Count ◽

Large Cohort ◽

Blood Eosinophil ◽

Study Cohort ◽

Inhaled Corticosteroid ◽

Exacerbation Rate ◽

Blood Eosinophil Count ◽

Copd Patients ◽

Blood Eosinophils

Abstract Background and objective: Inhaled corticosteroid (ICS) therapy for COPD should be guided by exacerbations and blood-eosinophils according to the GOLD 2020 strategy document. In the present study, we applied these recent recommendations in a large cohort of COPD patients recruited from general practice.Methods: The participating general practitioners (n = 144) recruited patients with a diagnosis of COPD currently prescribed ICS and reported data on exacerbation history and blood-eosinophils. Clinical variables were compared using two-sample t-tests.Results: The study cohort comprised 1,567 COPD patients (44% males and mean age 72 years). In the past 12 months, 849 (54%) of the COPD patients currently prescribed ICS had no exacerbation, whereas 383 (24%) and 328 (21%) patients, respectively, had a history of one exacerbation and two or more exacerbations. Compared to patients with one or no exacerbation, patients with ≥2 exacerbations (21%) per year reported more dyspnea (p<0.001) and had higher degree of airflow obstruction (p<0.001). Among patients with no and at least one exacerbation within the preceding 12 months, 30% and 26%, respectively, had a blood-eosinophil count ≥ 0.3 x 109/L. In patients with two or more exacerbations within the last 12 months, 77% had a blood-eosinophil count of ≥ 0.1 x 109/L. Furthermore, 166 patients (11%) had at least one hospital admission due to COPD exacerbation, and a blood-eosinophil count of ≥ 0.1 x 109/L.Conclusion: This study of a large cohort of COPD patients currently prescribed inhaled corticosteroids suggests the need for re-evaluating the management strategy to increase benefit and reduce adverse effects of ICS treatment in COPD patients managed in primary care.

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COPD patients prescribed inhaled corticosteroid in primary care – Time for re-assessment based on exacerbation rate and blood eosinophils?

10.21203/rs.3.rs-51349/v1 ◽

2020 ◽

Author(s):

Osman Savran ◽

Nina Skavlan Godtfredsen ◽

Torben Sørensen ◽

Christian Jensen ◽

Charlotte Ulrik

Keyword(s):

Primary Care ◽

Eosinophil Count ◽

Large Cohort ◽

Blood Eosinophil ◽

Study Cohort ◽

Inhaled Corticosteroid ◽

Exacerbation Rate ◽

Blood Eosinophil Count ◽

Copd Patients ◽

Blood Eosinophils

Abstract Background and objective Inhaled corticosteroid (ICS) therapy for COPD should be guided by exacerbations and blood eosinophils according to the GOLD 2020 strategy document. In the present study, we applied these recent recommendations in a large cohort of COPD patients recruited from general practice. Methods The participating general practitioners (n = 144) recruited patients with a diagnosis of COPD currently prescribed ICS and reported data on exacerbation history and blood-eosinophils. Clinical variables were compared using multinomial logistic regression. Results The study cohort comprised 1,567 COPD patients (44% males and mean age 73 years). In the past 12 months, 849 (54%) of the COPD patients currently prescribed ICS had had no exacerbation, whereas 383 (24%) and 328 (21%) patients, respectively, had a history of one exacerbation and two or more exacerbations. Compared to patients with one or no exacerbation, patients with ≥2 exacerbations (21%) per year reported more respiratory symptoms (p<0.001). Among patients with no and at least one exacerbation within the preceding 12 months, 30% and 27%, respectively, had a blood-eosinophil count ≥ 0.3 x 10 9 /L. In patients with two or more exacerbations within the last 12 months, 77% had a blood-eosinophil count of ≥ 0.1 x 10 9 /L. Furthermore, 166 patients (11%) had at least one hospital admission due to COPD exacerbation, and a blood-eosinophil count of ≥ 0.1 x 10 9 /L. Conclusion This study of a large cohort of COPD patients currently prescribed inhaled corticosteroids suggest the need for re-evaluating the management strategy to increase benefit and reduce adverse effects of ICS treatment in COPD patients managed in primary care.

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Dermatology in primary care: an audit of the proportion of patients who present to general practice with a dermatological problem that could be self-managed

British Journal of General Practice ◽

10.3399/bjgp20x711053 ◽

2020 ◽

Vol 70 (suppl 1) ◽

pp. bjgp20X711053

Author(s):

Luamar Dolfini ◽

Yogesh Patel

Keyword(s):

Primary Care ◽

General Practice ◽

Acne Vulgaris ◽

Clinical Information ◽

Electronic Record ◽

Self Management ◽

Considerable Proportion ◽

Dry Skin ◽

Record System ◽

Common Skin

BackgroundA considerable proportion of GPs’ workload is dermatological. It is important to investigate what common skin conditions encountered in primary care can be self-managed, in an effort to alleviate the burden on primary care.AimThe purpose of the audit was to identify the proportion of consultations that are dermatological in nature and analyse potential for self-management by patients.MethodData was collected using the patient electronic record system (EMIS) in general practice. A search was made for all consultations from the 17 April to 15 May 2019, which included all new presenting complaints that were dermatological in nature. The criteria for self-management included advising over the counter (OTC) medication or reassurance. On the other hand, a case was deemed not self-manageable if prescription only medication (POM) was prescribed or if a referral to dermatology was made.ResultsThere were a total of 2175 consultations, where 246 (11.31%) cases were dermatological. Of the 246, 80 cases (32.5%) could be self-managed. There were 46 different dermatological presenting complaints of which the 5 most common included: rash (51 cases), dermatitis (44 cases), acne vulgaris (13 cases), moles (12 cases), dry skin (11 cases). None of the acne or moles cases could be self-managed, whereas 23%, 68.2%, 72.7% of rashes, dermatitis, and dry skin cases, respectively, could be self-managed.ConclusionCertain dermatological conditions have more potential for self-management than others. Research into teledermatology as a means of addressing patient concern and providing clinical information is important in order to reduce unnecessary consultations.

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