Managing Chronic Obstructive Pulmonary Disease in the Community

Boxall, Anne-Marie; Barclay, Louise; Sayers, Allyn; Caplan, Gideon A.

doi:10.1097/00008483-200511000-00012

Cited by 108 publications

(68 citation statements)

References 26 publications

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“…There may be unobserved confounding despite propensity matching. Reductions in LOS after rehabilitation have also been reported in some RCTs 24,25 and observational studies 26 whereas a reduction in LOS was not observed in this cohort. Reasons for this may include the fact that patients in our analysis are older and frailer and possibly have more comorbidities than those who participated in the RCTs.…”

Section: Discussionsupporting

confidence: 74%

Effects of Pulmonary Rehabilitation on Exacerbation Number and Severity in People With COPD

Moore

Newson

Joshi

et al. 2017

Chest

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Conflict of Interest DisclosuresJKQ reports grants from the Medical Research Council (MRC), GlaxoSmithKline (GSK), British Lung Foundation (BLF), Wellcome Trust, during the conduct of the study, and personal fees from AstraZeneca and Boehringer Ingelheim, outside of the submitted work. MS reports other current research grants from Arthritis Research UK, Public Health England and the EU EITHealth Programme, with no conflicts of interest. SS reports grants from the National Institute for Health Research (NIHR), GlaxoSmithKline (GSK), Boehringer Ingelheim and Novartis and personal fees from Novartis and AstraZeneca. All other authors report no other conflicts of interest. 2 AbstractBackground: In previous systematic reviews, predominantly of randomised controlled trials,

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Section: Discussionsupporting

confidence: 74%

Effects of Pulmonary Rehabilitation on Exacerbation Number and Severity in People With COPD

Moore

Newson

Joshi

et al. 2017

Chest

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“…Five studies were not examined; three studies were only available as English abstracts as the articles were published in Spanish,20 French,21 and Chinese 22. Boxall23 was not used in the form, ie, congress abstract, in which it was used in the Cochrane review, it was instead published as an article in 2006 24. Chlumsky 200125 was not found.…”

Section: Methodsmentioning

confidence: 99%

Does pulmonary rehabilitation work in clinical practice? A review on selection and dropout in randomized controlled trials on pulmonary rehabilitation

Bjoernshave

Korsgaard

Nielsen

2010

CLEP

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Aim:To analyze randomized controlled trials (RCTs) on pulmonary rehabilitation (PR) to determine whether the patients who complete PR form a representative subset of the chronic obstructive pulmonary disease (COPD) target population and to discuss what impact this may have for the generalizability and implementation of PR in practice.Material and methods:A review of 26 RCTs included in a Cochrane Review 2007. We analyzed the selection at three different levels: 1) sampling; 2) inclusion and exclusion; 3) and dropout.Results:Of 26 studies only 3 (12%) described the sampling as the number of patients contacted. In these studies 28% completed PR. In all we found, that 75% of the patients suitable for PR programs were omitted due to sampling exclusion and dropout. Most of the study populations are not representative of the target population.Conclusion:The RCTs selected for the Cochrane review gave sparse information about the sampling procedure. The demand for high internal validity in studies on PR reduced their external validity. The patients completing PR programs in RCTs were not drawn from a representative subset of the target population. The ability to draw conclusions relevant to clinical practice from the results of the RCTs on PR is impaired.

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“…Table 7 summarises the type of interventions that were employed in the studies included in the review of complex interventions in COPD, and the duration of the intervention. 118,120,121,123,125,129,130,138,139,142,148 ), behaviour therapy (zero studies), relapse prevention (11 studies 117,118,121,124,127,129,132,135,140,144,147 ), problem-solving (zero studies), cognitive-behavioural therapy (CBT) (zero studies), increased social support (zero studies) and relaxation therapy (four studies 118,121,125,146 ). The forest plot for the meta-analysis is shown in Figure 12.…”

Section: Figure 11mentioning

confidence: 99%

“…Bergner 119 Bergner 119 Bourbeau 118 Boxall 120 Casas 114 Eaton 121 Farrero 122 Gadoury 123 Gallefoss 124 Güel 125 Hermiz 126 Hernandez 127 Jarab 128 Khdour 129 Ko 130 Koff 131 Lee 132…”

Section: -181mentioning

confidence: 99%

CHOICE: Choosing Health Options In Chronic Care Emergencies

Guthrie

Afzal

Blakeley

et al. 2017

Programme Grants Appl Res

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BackgroundOver 70% of the health-care budget in England is spent on the care of people with long-term conditions (LTCs), and a major cost component is unscheduled health care. Psychological morbidity is high in people with LTCs and is associated with a range of adverse outcomes, including increased mortality, poorer physical health outcomes, increased health costs and service utilisation.ObjectivesThe aim of this programme of research was to examine the relationship between psychological morbidity and use of unscheduled care in people with LTCs, and to develop a psychosocial intervention that would have the potential to reduce unscheduled care use. We focused largely on emergency hospital admissions (EHAs) and attendances at emergency departments (EDs).DesignA three-phase mixed-methods study. Research methods included systematic reviews; a longitudinal prospective cohort study in primary care to identify people with LTCs at risk of EHA or ED admission; a replication study in primary care using routinely collected data; an exploratory and feasibility cluster randomised controlled trial in primary care; and qualitative studies to identify personal reasons for the use of unscheduled care and factors in routine consultations in primary care that may influence health-care use. People with lived experience of LTCs worked closely with the research team.SettingPrimary care. Manchester and London.ParticipantsPeople aged ≥ 18 years with at least one of four common LTCs: asthma, coronary heart disease, chronic obstructive pulmonary disease (COPD) and diabetes. Participants also included health-care staff.ResultsEvidence synthesis suggested that depression, but not anxiety, is a predictor of use of unscheduled care in patients with LTCs, and low-intensity complex interventions reduce unscheduled care use in people with asthma and COPD. The results of the prospective study were that depression, not having a partner and life stressors, in addition to prior use of unscheduled care, severity of illness and multimorbidity, were independent predictors of EHA and ED admission. Approximately half of the cost of health care for people with LTCs was accounted for by use of unscheduled care. The results of the replication study, carried out in London, broadly supported our findings for risk of ED attendances, but not EHAs. This was most likely due to low rates of detection of depression in general practitioner (GP) data sets. Qualitative work showed that patients were reluctant to use unscheduled care, deciding to do so when they perceived a serious and urgent need for care, and following previous experience that unscheduled care had successfully and unquestioningly met similar needs in the past. In general, emergency and primary care doctors did not regard unscheduled care as problematic. We found there are missed opportunities to identify and discuss psychosocial issues during routine consultations in primary care due to the ‘overmechanisation’ of routine health-care reviews. The feasibility trial examined two levels of an intervention for people with COPD: we tried to improve the way in which practices manage patients with COPD and developed a targeted psychosocial treatment for patients at risk of using unscheduled care. The former had low acceptability, whereas the latter had high acceptability. Exploratory health economic analyses suggested that the practice-level intervention would be unlikely to be cost-effective, limiting the value of detailed health economic modelling.LimitationsThe findings of this programme may not apply to all people with LTCs. It was conducted in an area of high social deprivation, which may limit the generalisability to more affluent areas. The response rate to the prospective longitudinal study was low. The feasibility trial focused solely on people with COPD.ConclusionsPrior use of unscheduled care is the most powerful predictor of unscheduled care use in people with LTCs. However, psychosocial factors, particularly depression, are important additional predictors of use of unscheduled care in patients with LTCs, independent of severity and multimorbidity. Patients and health-care practitioners are unaware that psychosocial factors influence health-care use, and such factors are rarely acknowledged or addressed in consultations or discussions about use of unscheduled care. A targeted patient intervention for people with LTCs and comorbid depression has shown high levels of acceptability when delivered in a primary care context. An intervention at the level of the GP practice showed little evidence of acceptability or cost-effectiveness.Future workThe potential benefits of case-finding for depression in patients with LTCs in primary care need to be evaluated, in addition to further evaluation of the targeted patient intervention.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Managing Chronic Obstructive Pulmonary Disease in the Community

Cited by 108 publications

References 26 publications

Effects of Pulmonary Rehabilitation on Exacerbation Number and Severity in People With COPD

Effects of Pulmonary Rehabilitation on Exacerbation Number and Severity in People With COPD

Does pulmonary rehabilitation work in clinical practice? A review on selection and dropout in randomized controlled trials on pulmonary rehabilitation

CHOICE: Choosing Health Options In Chronic Care Emergencies

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