@article{581bf75907db4d52b8b986d057e9a2c5,
title = "Associations with Post-Consultation Health-Status in Primary Care Managed Acute Exacerbation of COPD",
abstract = "Background: It has been demonstrated that antibiotic prescribing for Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD) can be safely reduced in primary care when general practitioners have access to C-reactive protein (CRP) rapid testing. Aim: To investigate the factors associated with post-consultation COPD health status in patients presenting with AECOPD in this setting. Design and Setting: A cohort study of patients enrolled in a randomised controlled trial. Patients aged 40+ years with a clinical diagnosis of COPD who presented in primary care across England and Wales with an AECOPD were included. Methods: Participants were contacted for follow-up at one-and two-weeks by phone and attended the practice four weeks after the index consultation. The outcome of interest was the Clinical COPD Questionnaire (CCQ) score. Multivariable multilevel linear regression models fitted to examine the factors associated with COPD health status in the four-weeks following consultation for an AECOPD. Results: A total of 649 patients were included, with 1947 CCQ total scores analysed. Post-consultation CCQ total scores were significantly higher (worse) in participants with diabetes (adjusted mean difference [AMD]=0.26; 95% confidence interval (CI) 0.08– 0.45), obese patients compared to those with normal body mass index (AMD = 0.25, 95% CI 0.07–0.43), and those who were prescribed oral antibiotics in the prior 12 months (AMD = 0.26; 95% CI 0.11–0.41), but only the two latter associations remained after adjusting for other sociodemographic variables. Conclusion: COPD health status was worse in the four weeks following primary care consultation for AECOPD in patients with obesity and those prescribed oral antibiotics in the preceding year.",
keywords = "Chronic obstructive, Health status, Primary Health Care, Pulmonary disease, Symptom exacerbation",
author = "David Gillespie and Nick Francis and Haroon Ahmed and Kerenza Hood and Carl Llor and Patrick White and Emma Thomas-Jones and Helen Stanton and Bernadette Sewell and Rhiannon Phillips and Gurudutt Naik and Hasse Melbye and Rachel Lowe and Nigel Kirby and Ann Cochrane and Janine Bates and Alam, {Mohammed Fasihul} and Christopher Butler",
note = "Funding Information: We would like to thank all patients who participated in the trials and their families, without whom this study would not have been possible. We would also like to acknowledge the contribution of other members of the original trial team (Angela Watkins, Miguel Cossio, Stephanie Robinson, Christy Barlow, Megan Philips-Laird, Deborah Fitzsimmons, and Micaela Gal. Margaret Barnard (who passed away in April 2016) and Jonathan Bidmead provided patient and public representation on the Trial Management Group. Jacqueline Nuttall provided study design input). Two UK Clinical Research Collaboration registered clinical trial units were involved in the study: Centre for Trials Research, Cardiff University; and University of Oxford Primary Care and Vaccines Clinical Trials Collaborative. We would also like to acknowledge and thank the Health & Care Research Wales Workforce, the following CRNs for their support in helping to identify sites and carry out notes reviews at these sites: Thames Valley & South Midlands CRN, East Midlands CRN, West Midlands CRN, West of England CRN, North Thames CRN, North West London CRN and South London CRN. We would like to express our thanks to Abbott Rapid Diagnostics, formally Alere Ltd, which provided the Afinion analysers and CRP cartridges and QC cartridges to the recruitment sites at no cost. Alere provided training on the use of the CRP POCT to a number of the participating sites. The Centre for Trials Research is funded by Health & Care Research Wales and Cancer Research UK. Funding Information: The study was supported by funds from the NIHR Health Technology Assessment Programme (project number 12/33/12). Funding Information: Authors DG, NF, HA, KH, PW, ET-J, BS, GN, RL, NK, JB, and CCB report grants from the National Institute for Health Research during the conduct of this study. NF also reports payments from Abbott for chairing and presenting at scientific meeting. CL reports grants from Abbott Diagnostics outside of the submitted work. RP reports grants from Health and Care Research Wales Research for Public and Patient Benefit, grants from Welsh Government/Ser Cymru, grants from Kidney Research UK and British Renal Society, grants from National Institute for Health Research Health Technology Assessment outside the submitted work. All other authors (HS, HM, AC, and MFA) report no potential competing interests. Publisher Copyright: {\textcopyright} 2022 Gillespie et al.",
year = "2022",
doi = "10.2147/COPD.S340710",
language = "English",
volume = "17",
pages = "383--394",
journal = "International Journal of COPD",
issn = "1176-9106",
}