Identification of key opportunities for optimising the management of high-risk COPD patients in the UK using the CONQUEST quality standards: an observational longitudinal study.

Autor:	Halpin DMG; University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK.; Observational and Pragmatic Research Institute, Singapore., Dickens AP; Observational and Pragmatic Research Institute, Singapore., Skinner D; Optimum Patient Care, UK., Murray R; Optimum Patient Care, UK., Singh M; General Practice, Horse Fair Practice Group, Rugeley, Staffordshire, UK.; Keele University Medical School, Keele, UK.; Staffordshire Integrated Care System, UK., Hickman K; National Asthma and COPD Audit Programme, Care Quality Improvement Department (CQID), RCP, London, UK.; Low Moor Medical Practice, Bradford, UK.; Leeds and Bradford Clinical Commissioning Groups, UK., Carter V; Optimum Patient Care, UK., Couper A; Observational and Pragmatic Research Institute, Singapore., Evans A; Optimum Patient Care, UK., Pullen R; Observational and Pragmatic Research Institute, Singapore., Menon S; Medical and Scientific Affairs, AstraZeneca, London, UK., Morris T; Medical and Scientific Affairs, AstraZeneca, London, UK., Muellerova H; BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK., Bafadhel M; School of Immunology & Microbial Science, King's College, London, UK., Chalmers J; Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK., Devereux G; Liverpool School of Tropical Medicine, Liverpool, UK., Gibson M; Salford Royal NHS Foundation Trust & Chief Executive Officer of NorthWest EHealth, UK., Hurst JR; UCL Respiratory, University College London, London, UK., Jones R; Plymouth Marjon University, Plymouth, UK., Kostikas K; Respiratory Medicine Department, University of Ioannina, Greece., Quint J; Respiratory Epidemiology, Faculty of Medicine, National Heart & Lung Institute, London, UK., Singh D; Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, UK., van Melle M; Observational and Pragmatic Research Institute, Singapore.; Connecting Medical Dots BV, Utrecht, the Netherlands.; ORTEC, Zoetermeer, the Netherlands., Wilkinson T; University of Southampton Faculty of Medicine, Southampton, UK.; National Institute for Health and Care Research Southampton Biomedical Research Centre, Southampton, UK., Price D; Observational and Pragmatic Research Institute, Singapore.; Optimum Patient Care, UK.; Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
Jazyk:	angličtina
Zdroj:	The Lancet regional health. Europe [Lancet Reg Health Eur] 2023 Apr 21; Vol. 29, pp. 100619. Date of Electronic Publication: 2023 Apr 21 (Print Publication: 2023).
DOI:	10.1016/j.lanepe.2023.100619
Abstrakt:	Background: This study compared management of high-risk COPD patients in the UK to national and international management recommendations and quality standards, including the COllaboratioN on QUality improvement initiative for achieving Excellence in STandards of COPD care (CONQUEST). The primary comparison was in 2019, but trends from 2000 to 2019 were also examined. Methods: Patients identified in the Optimum Patient Care Research Database were categorised as newly diagnosed (≤12 months after diagnosis), already diagnosed, and potential COPD (smokers having exacerbation-like events). High-risk patients had a history of ≥2 moderate or ≥1 severe exacerbations in the previous 12 months. Findings: For diagnosed patients, the median time between diagnosis and first meeting the high-risk criteria was 617 days (Q1-Q3: 3246). The use of spirometry for diagnosis increased dramatically after 2004 before plateauing and falling in recent years. In 2019, 41% (95% CI 39-44%; n = 550/1343) of newly diagnosed patients had no record of spirometry in the previous year, and 45% (95% CI 43-48%; n = 352/783) had no record of a COPD medication review within 6 months of treatment initiation or change. In 2019, 39% (n = 6893/17,858) of already diagnosed patients had no consideration of exacerbation rates, 46% (95% CI 45-47%; n = 4942/10,725) were not offered or referred for pulmonary rehabilitation, and 41% (95% CI 40-42%; n = 3026/7361) had not had a COPD review within 6 weeks of respiratory hospitalization. Interpretation: Opportunities for early diagnosis of COPD patients at high risk of exacerbations are being missed. Newly and already diagnosed patients at high-risk are not being assessed or treated promptly. There is substantial scope to improve the assessment and treatment optimisation of these patients. Funding: This study is conducted by the Observational & Pragmatic Research International Ltd and was co-funded by Optimum Patient Care and AstraZeneca. No funding was received by the Observational & Pragmatic Research Institute Pte Ltd (OPRI) for its contribution. Competing Interests: David MG Halpin has received sponsorship to attend international meetings, and honoraria for lecturing, attending advisory boards and preparing educational materials from AstraZeneca, Boehringer Ingelheim, Chiesi, GSK, Novartis and Pfizer. Andrew P. Dickens, Rachel Pullen, and Amy Couper, are employees of the Observational and Pragmatic Research Institute, which is a research collaborator of the CONQUEST initiative with Optimum Patient Care and AstraZeneca. Alexander Evans, Victoria Carter, Derek Skinner and Ruth Murray are employees of Optimum Patient Care, UK, which is a research collaborator of the CONQUEST initiative with Optimum Patient Care and AstraZeneca. Mukesh Singh reports personal fees from AstraZeneca, Boehringer Ingelheim, Cheisi, GlaxoSmithKline, Napp/Mundipharma, Pfizer, Teva. Tamsin Morris, Shruti Menon and Hana Muellerova are employees of AstraZeneca and hold stock and/or stock options in the company. AstraZeneca is a co-funder of the CONQUEST initiative. Mona Bafadhel reports grants from AstraZeneca and personal fees and non-financial support from AstraZeneca, Chiesi, GSK and others from AlbusHealth, outside the submitted work. James Chalmers has received research grants or consultancy fees from AstraZeneca, Boehringer Ingelheim, Gilead Sciences, GlaxoSmithKline, Grifols, Insmed and Zambon. Katherine Hickman, Graham Devereux, Martin Gibson, Jennifer Quint, and Marije van Melle report no conflicts of interest. John Hurst has received personal payment and payment to his institution (UCL), including research grants, reimbursement for advisory work and educational activities, and support to attend meetings from pharmaceutical companies that make medicines to treat COPD, which includes AstraZeneca, Boehringer Ingelheim, Chiesi, and Novartis. Rupert C. Jones declares grants from AstraZeneca, GlaxoSmithKline, Novartis, and Teva, and personal fees for consultancy, speakers’ fees or travel support from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis, and Observational & Pragmatic Research Institute Pte Ltd (OPRI). Konstantinos Kostikas has received honoraria for presentations and consultancy fees from AstraZeneca, Boehringer Ingelheim, CSL Behring, Chiesi, ELPEN, GILEAD, GSK, Menarini, Novartis, Sanofi, Specialty Therapeutics; WebMD (paid to the University of Ioannina); his department has received funding and grants from AstraZeneca, Boehringer Ingelheim, Chiesi, Innovis, ELPEN, GSK, Menarini, Novartis and NuvoAir (paid to the University of Ioannina); KK is a member of the GOLD Assembly. Dave Singh has received personal fees from GSK, Cipla, Genentech and Peptinnovate, and personal fees and grant support from AstraZeneca, Boehringer Ingelheim, Chiesi, Glenmark, Gossamerbio, Menarini, Mundipharma, Novartis, Pfizer, Pulmatrix, Theravance, and Verona. Tom Wilkinson is the co-founder, shareholder and director of Mymhealth Limited; he has received grants or consultancy fees from GSK, AstraZeneca, Janssen, Bergenbio, UCB, Olam, Valneva, Synairgen, Novavax, Teva, BI. David Price has advisory board membership with AstraZeneca, Boehringer Ingelheim, Chiesi, Mylan, Novartis, Regeneron Pharmaceuticals, Sanofi Genzyme, Thermofisher; consultancy agreements with Airway Vista Secretariat, AstraZeneca, Boehringer Ingelheim, Chiesi, EPG Communication Holdings Ltd, FIECON Ltd, Fieldwork International, GlaxoSmithKline, Mylan, Mundipharma, Novartis, OM Pharma SA, PeerVoice, Phadia AB, Spirosure Inc, Strategic North Limited, Synapse Research Management Partners S.L., Talos Health Solutions, Theravance and WebMD Global LLC; grants and unrestricted funding for investigator-initiated studies (conducted through Observational and Pragmatic Research Institute Pte Ltd) from AstraZeneca, Boehringer Ingelheim, Chiesi, Mylan, Novartis, Regeneron Pharmaceuticals, Respiratory Effectiveness Group, Sanofi Genzyme, Theravance and UK National Health Service; payment for lectures/speaking engagements from AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, GlaxoSmithKline, Kyorin, Mylan, Mundipharma, Novartis, Regeneron Pharmaceuticals and Sanofi Genzyme; payment for travel/accommodation/meeting expenses from AstraZeneca, Boehringer Ingelheim, Mundipharma, Mylan, Novartis, Thermofisher; stock/stock options from AKL Research and Development Ltd which produces phytopharmaceuticals; owns 74% of the social enterprise Optimum Patient Care Ltd (Australia and UK) and 92.61% of Observational and Pragmatic Research Institute Pte Ltd (Singapore); 5% shareholding in Timestamp which develops adherence monitoring technology; is peer reviewer for grant committees of the UK Efficacy and Mechanism Evaluation programme, and Health Technology Assessment; and was an expert witness for GlaxoSmithKline. (© 2023 The Author(s).)
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