Impact of COPD case finding on clinical care: a prospective analysis of the TargetCOPD trial
| Autor: | Rachel Jordan, Kiran Rai, Alice J Sitch, Andy Dickens, Alexandra Enocson, David Fitzmaurice, Peymane Adab, Shamil Haroon |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
medicine.medical_specialty Psychological intervention Odds Pulmonary Disease Chronic Obstructive primary care Internal medicine Forced Expiratory Volume Surveys and Questionnaires Health care medicine Humans Cluster randomised controlled trial Prospective Studies Clinical care Respiratory Medicine Aged COPD Primary Health Care business.industry Public health public health General Medicine Middle Aged medicine.disease chronic airways disease Quality of Life Case finding Medicine business |
| Zdroj: | BMJ Open BMJ Open, Vol 10, Iss 10 (2020) |
| ISSN: | 2044-6055 |
| Popis: | ObjectivesTo investigate the impact of chronic obstructive pulmonary disease (COPD) case finding on clinical care.DesignWe conducted a prospective observational analysis of data from a pragmatic cluster randomised controlled trial in primary care in the West Midlands, UK (TargetCOPD). This compared alternative methods of COPD case finding against usual care. Data were extracted from electronic healthcare records and self-reported questionnaires for a subset of patients with newly diagnosed COPD.Setting50 general practices that participated in the TargetCOPD trial.ParticipantsPatients aged 40–79 years newly identified with COPD by targeted case finding or by usual care, from 10 August 2012 to 22 June 2014.Primary and secondary outcome measuresThe primary outcome was addition to a COPD register by the end of the trial. The secondary outcome was a clinical care score, derived from the sum of clinical assessments and relevant interventions. Associations between participant characteristics and the primary and secondary outcomes were assessed using multilevel regression.Results857 patients identified with COPD by case finding and 764 by usual care were included. Only 21.2% of case-found patients had been added to a COPD register, compared with 92.7% of those diagnosed by usual care. The odds of being added were greater in smokers (adjusted OR 8.68, 95% CI 2.53 to 29.8), and in those with lower percentage of predicted forced expiratory volume in 1 s (adjusted OR 0.96 per percentage rise, 95% CI 0.95 to 0.98). Patients who had been added to a COPD register had a significantly higher clinical care score (mean difference 5.06, 95% CI 4.36 to 5.75).ConclusionsOnly one in five case-found patients had been registered with COPD. Patients added to a COPD register received significantly higher levels of appropriate clinical care.Trial registration numberISRCTN14930255; Post-results. |
| Databáze: | OpenAIRE |
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