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Comparing health status between patients with COPD in primary, secondary and tertiary care.

ABSTRACT: In this study, we compare health status between COPD patients treated in three different care levels in the Netherlands and assess determinants that influence their health status. We applied the Nijmegen Clinical Screening Instrument to measure eight health status subdomains in primary (n?=?289), secondary (n?=?184) and tertiary care (n?=?433) COPD patient cohorts. Proportions of patients with severe problems in ?3 subdomains are 47% in primary, 71% in secondary and 94% in tertiary care. Corrected for patient characteristics, differences between the care levels are statistically significant for nearly all health status subdomains. The pooled cohort data show female sex, age, FEV1 % predicted and BMI to be determinants of one or more subdomains. We conclude that the proportion of COPD patients with severe health status problems is substantial, not just in tertiary care but also in primary and secondary care. Use of detailed health status information may support patient-tailored COPD care.

SUBMITTER: de Klein MM

PROVIDER: S-EPMC7478961 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Comparing health status between patients with COPD in primary, secondary and tertiary care.

de Klein Mieke M MM Peters Jeannette B JB van 't Hul Alex J AJ Akkermans Reinier P RP In 't Veen Johannes C JC Vercoulen Jan H JH Bischoff Erik W EW Schermer Tjard R TR

NPJ primary care respiratory medicine 20200908 1

In this study, we compare health status between COPD patients treated in three different care levels in the Netherlands and assess determinants that influence their health status. We applied the Nijmegen Clinical Screening Instrument to measure eight health status subdomains in primary (n = 289), secondary (n = 184) and tertiary care (n = 433) COPD patient cohorts. Proportions of patients with severe problems in ≥3 subdomains are 47% in primary, 71% in secondary and 94% in tertiary care. Correct ...[more]

PMID: 32901030

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Project description:BackgroundFor patients with coronary heart diseases a substantial part of secondary prevention is delivered in primary care. Along with the growing importance of prevention, health-related quality of life (HRQoL) is an indicator of patient-centered care that has gained increased attention. Different approaches for reorganization in primary care have been associated with improvements in HRQoL. However, these are often results of complex interventions. Evidence on aspects concerning usual primary care that actually have an impact on HRQoL remains scarce. Therefore, this observational study aimed to identify factors which are associated with HRQoL in usual primary care at practice and patient-level.MethodsThis observational study was conducted in eight European countries. We were able to match data from survey instruments for 3505 patients with coronary heart disease (CHD) in 228 practices. A multilevel analysis was performed to identify associations of EQ-5D scores at patient and practice-level.ResultsAfter dropping patients with missing information, our cohort consisted of 2656 patients. In this sample, 30.5% were female and the mean age was 67.5 years (SD 10.1). The final model included a total set of 14 potential explanatory variables. At practice-level no variable was associated with EQ-5D. At patient-level, lower education (r =?-0.0381, p<0.0001), female gender (r =?-0.0543, p<0.0001) and a higher number of other conditions (r =?-0.0340, p<0.0001), had a strong negative effect on HRQoL. Strong positive associations with HRQoL were found for a good medication adherence (Morisky) (r = 0.0195, p<0.0001) and more positive evaluations of physicians' clinical behavior (r = 0.0282, p = 0.002). In terms of HRQoL no differences between single-handed and group practices exist.ConclusionThe results of our study suggest that a better patient-physician relationship rather than organization of CHD care is associated with higher HRQOL in the primary care setting. The results may imply that interventions to improve HRQoL require a strong patient-centered approach.

Dataset Information

Comparing health status between patients with COPD in primary, secondary and tertiary care.

Publications

Comparing health status between patients with COPD in primary, secondary and tertiary care.

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