Characteristics, Management and In-Hospital Clinical Outcomes Among Inpatients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease in China: Results from the Phase I Data of ACURE Study

Liang, Chen; Mao, Xihua; Niu, Hongtao; Huang, Ke; Dong, Fen; Chen, Yahong; Huang, Kewu; Zhan, Qingyuan; Huang, Yen-Chieh; Zhang, Yaowen; Yang, Ting; Wang, Chen

doi:10.2147/copd.s281957

Cited by 17 publications

(14 citation statements)

References 44 publications

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“…Although the efforts to teach CS and establish patient-centered communication have shown promising results [ 8 ], this approach is not common practice in Chinese clinical settings [ 28 , 29 ]. Tertiary-care hospitals seem to be faring better in clinical aspects [ 30 , 31 ] but a national framework for medical professionalism among Chinese physicians is yet to be enforced [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Communication Skills (CS) training of physicians in China and its role in actual challenges of patient-physician relationship: a cross-sectional survey

Mayer

Posenato

et al. 2022

BMC Med Educ

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Background The Chinese healthcare system is affected by frequent disputes between physicians and patients. Although recent reforms have contributed towards improving the patient-physician relationship, distrust in physicians is still high. Communication skills (CS) training of physicians holds the key to improving patient confidence and diffusing stressful situations. This survey reports on the status of CS training in medical education in China, and the experiences and attitudes of physicians towards CS training. Methods A cross-sectional survey was conducted at medical institutions across China. A questionnaire developed for this study included the status of CS training, current aspects of patient-physician relationships, perceived own CS and patient-centeredness with Likert-scaled items from 1 (most negative) to 6 (most positive). Physicians’ attitude towards CS training was measured with the Communication Skills Attitude Scale (CSAS) and its subscales PAS (Positive Attitude Scale) and NAS (Negative Attitude Scale). Data were analyzed descriptively and for group differences between the hospital level and operating vs. non-operating physicians. Binary logistic regression analysis was done to find associations explaining the occurrence of verbal and physical attacks and the role of CS attitudes. Results Out of 1080 questionnaires, 772 physicians met inclusion criteria. A total of 466/772 participants (60.4%) had received at least one CS training during their career. The participants rated the current situation related to patient-physician relationship in China as highly stressful (mean = 4.52, SD = 1.26, 95% CI: 4.43–4.60), experiencing verbal attacks in the past three years once a year in 372/772 cases (48.2%) and physical attacks 111/772 times (14.4%). The mean PAS was 62.96 (SD = 7.63, 95% CI: 62.41–63.47). Being female was associated with increased risk of verbal attacks (OR = 1.51, 95% CI: 1.01–2.25) while working in a tertiary hospital and showing high levels of PAS decreased this risk (OR = 0.62, 95% CI: 0.43–0.89, and OR = 0.95, 95% CI: 0.93–0.98). Having received a previous CS training decreased the odds of physical attacks (OR = 0.54, 95% CI: 0.35–0.83). Conclusions A majority of Chinese physicians showed a high positive attitude towards CS training, were trained in CS and would value further training. Our results highlight that CS training is likely to promote patient-centered communication and reduce attacks against physicians. Both of these effects are to improve the patient-physician-relationship in the long run. More CS training should be offered to Chinese physicians, especially at secondary- and primary-care hospitals, where such practices remain infrequent.

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Section: Introductionmentioning

confidence: 99%

Communication Skills (CS) training of physicians in China and its role in actual challenges of patient-physician relationship: a cross-sectional survey

Mayer

Posenato

et al. 2022

BMC Med Educ

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“…We observed that clinical management of COPD during the stable period was unsatisfactory in China in another analysis of ACURE database. 13 Therefore, it needs to strengthen management of COPD in the stable stage needs to be popularized and strengthened, which could then delay the decline of lung function and reduce acute exacerbation of COPD. Third, PHD treatment is mainly to maintain lung function and oxygen therapy, which has remained almost unchanged for the past 3 decades.…”

Section: Discussionmentioning

confidence: 99%

“…Details of the data collection have been described in previously published paper. 13 According to the 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD), the severity of airflow limitation was classified into four grades: GOLD 1 (forced expiratory volume in the first second, FEV 1 % predicted ≥ 80), GOLD 2 (50 ≤ FEV 1 % predicted < 80), GOLD 3 (30 ≤ FEV 1 % predicted < 50), and GOLD 4 (FEV 1 % predicted < 30). ECG and echocardiography were performed during the hospitalization.…”

Section: Methodsmentioning

confidence: 99%

Clinical Features and Outcomes of Acute Exacerbation in Chronic Obstructive Pulmonary Disease Patients with Pulmonary Heart Disease: A Multicenter Observational Study

You¹,

Niu²,

Huang³

et al. 2021

COPD

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Purpose To identify clinical features and outcomes associated with pulmonary heart disease among patients with chronic obstructive pulmonary disease exacerbation (COPD), which may help reduce economic burden accrued over hospital stay and shorten length of stay (LOS). Patients and Methods Totally, 4386 patients with acute exacerbation of COPD (AECOPD) classified into pulmonary heart disease (PHD) group and non-pulmonary heart disease group, were included from the ACURE registry, a prospective multicenter patient registry study. Clinical features and outcomes were compared between groups. Results PHD patients had a more severe profile, including having higher scores of COPD assessment test and modified British Medical Research Council, worse lung function, more patients hospitalized more than once in the past year due to acute exacerbation of COPD, and more comorbidities. Furthermore, drug cost was higher and length of stay was longer in AECOPD patients with PHD. Conclusion AECOPD patients with PHD had a more severe profile and worse clinical outcomes, including higher drug cost and longer LOS. PHD is an independent risk factor of drug cost and LOS. Complicated with PHD in COPD/AECOPD patients with PHD means heavier disease burden and worse prognosis. It merits further study to focus on PHD management in COPD/AECOPD patients.

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“…The ACURE study was started on September 1, 2017 and planned to recruit 7,600 hospitalized patients with AECOPD who were admitted to 161 participating medical centers across China with a maximum of 3-year follow-up. The protocol of the ACURE registry and baseline characteristics of the study population have been published (31,32).…”

Section: Study Design and Settingsmentioning

confidence: 99%

Comparison of Clinical Characteristics and Short-Term Prognoses Within Hospitalized Chronic Obstructive Pulmonary Disease Patients Comorbid With Asthma, Bronchiectasis, and Their Overlaps: Findings From the ACURE Registry

Lei

Yang

Liang³

et al. 2022

Front. Med.

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IntroductionReal-world evidence and comparison among commonly seen chronic obstructive pulmonary disease (COPD) phenotypes, i.e., asthma–COPD overlap (ACO), bronchiectasis–COPD overlap (BCO), and their coexistence (ABCO) have not been fully depicted, especially in Chinese patients.MethodsData were retrieved from an ongoing nationwide registry in hospitalized patients due to acute exacerbation of COPD in China (ACURE).ResultsOf the eligible 4,813 patients with COPD, 338 (7.02%), 492 (10.22%), and 63 (1.31%) were identified as ACO, BCO, and ABCO phenotypes, respectively. Relatively, the ABCO phenotype had a younger age with a median of 62.99 years [interquartile range (IQR): 55.93–69.48] and the COPD phenotype had an older age with a median of 70.15 years (IQR: 64.37–76.82). The BCO and COPD phenotypes were similar in body mass index with a median of 21.79 kg/m2 (IQR: 19.47–23.97) and 21.79 kg/m2 (IQR: 19.49–24.22), respectively. The COPD phenotype had more male gender (79.90%) and smokers (71.12%) with a longer history of smoking (median: 32.45 years, IQR: 0.00–43.91). The ACO and ABCO phenotypes suffered more prior allergic episodes with a proportion of 18.05 and 19.05%, respectively. The ACO phenotype exhibited a higher level of eosinophil and better lung reversibility. Moreover, the four phenotypes showed no significant difference neither in all-cause mortality, intensive care unit admission, length of hospital stay, and COPD Assessment Test score change during the index hospitalization, and nor in the day 30 outcomes, i.e., all-cause mortality, recurrence of exacerbation, all-cause, and exacerbation-related readmission.ConclusionsThe ACO, BCO, ABCO, and COPD phenotypes exhibited distinct clinical features but had no varied short-term prognoses. Further validation in a larger sample is warranted.

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Characteristics, Management and In-Hospital Clinical Outcomes Among Inpatients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease in China: Results from the Phase I Data of ACURE Study

Cited by 17 publications

References 44 publications

Communication Skills (CS) training of physicians in China and its role in actual challenges of patient-physician relationship: a cross-sectional survey

Communication Skills (CS) training of physicians in China and its role in actual challenges of patient-physician relationship: a cross-sectional survey

Clinical Features and Outcomes of Acute Exacerbation in Chronic Obstructive Pulmonary Disease Patients with Pulmonary Heart Disease: A Multicenter Observational Study

Comparison of Clinical Characteristics and Short-Term Prognoses Within Hospitalized Chronic Obstructive Pulmonary Disease Patients Comorbid With Asthma, Bronchiectasis, and Their Overlaps: Findings From the ACURE Registry

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