Rambharos, M. (Mrinalini) (2017) GOLD A,B,C,D in de huisartsenpraktijk : Is er een verschil tussen de basiskenmerken van GOLD A-D patiënten in Nederland vergeleken met het Europees niveau? thesis, Medicine.
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Abstract
Introduction: Chronic obstructive pulmonary disease, COPD, is worldwide the most prevalent lung disease with a high mortality rate. COPD is highly prevalent in primary care. However, despite published Global Initiative for Chronic Obstructive Lung Disease (GOLD)-treatment guidelines, optimal treatment remains unclear. Furthermore, 50% of COPD-patients do not receive any medication indicating under treatment. In 2005, a specialized integrated care system, the Asthma/COPD service (AC-service) for general practitioners in the north of the Netherlands has been developed. This approach has led to a considerable improvement in overall health status and a decline in exacerbation rates in COPD-patients. Considering the scarce data about COPD-patient characteristics for optimal treatment, this study provides insight into patient characteristics of the Certe AC-service population. To assess the representativeness of the Certe AC-service patients on a broader scale, Certe data will be compared with a multinational UNLOCK dataset (Uncovering and Noting Long-Term Outcomes in COPD to Enhance Knowledge). This dataset consists of diagnostic and follow-up data related to COPD management in primary care in Europe. The objective of this study is to give an insight into baseline characteristics of COPD patients from the Certe AC-service and compare the patient characteristics from the AC-service with UNLOCK to assess the representativeness of the Certe AC-service patients at the European level. Methods: Baseline data of the Certe AC-service (N=556) were analyzed and compared per GOLD-category. This data is then compared with 2 primary care datasets of UNLOCK from Sweden and Greece (N=429) for the following variables: age, gender, smoking status, FEV1-%predicted (forced expiratory volume in 1 second), FEV1-FVC (forced vital capacity)-%post, CCQ-totalscore (Clinical COPD Questionnaire) and CCQ-categories. In addition, the inhalation technique and medication use for the Certe AC-service population has been analyzed. Statistical analysis was performed using the independent T-test and Chi-square test. Results: Age, gender and BMI (body mass index) showed no significant differences between the GOLD categories of the AC-service. Mean exacerbation rates were highest in risk groups C and D (GOLD C 67.7%; D 62.2% with at least 1 exacerbation/year). Inhalation technique was in nearly half of the patients of the AC-service insufficient (44.4%). Additionally, 22% of COPD patients did not use pulmonary medication at baseline, indicating large under treatment. Overall, compared to UNLOCK, patients from the Certe AC-service were significantly older (mean difference (MD) 4; p<0.01) with worse lung function (FEV1 MD 6.1; p<0.01), a lower CCQ-score (MD -0.5; p<0.01), more smokers (47.5% vs. 38.9%, p<0.01) and a higher exacerbation rate (33.8% vs 26.4%; p=0,02). The proportion of men was in both populations higher (AC-service 56.8%, UNLOCK 55%; p=0.6). The GOLD distribution between AC-service and UNLOCK showed the same pattern with a low prevalence of category C (AC-service 5.6% vs. UNLOCK 2.8%; p=0.03). Conclusion: Significant differences were found between the baseline characteristics of the Certe AC-service and UNLOCK. However, these difference are not clinically relevant. Furthermore, more attention for the inhalation technique and optimal treatment of COPD patients is needed. Given that the small differences in age, sex, smoking status and lung function are of no/little clinical implication, it can be tentatively concluded that the Certe AC-service patients are representative at the level of Greece and Sweden. More research is needed in which AC-service data will be evaluated and compared with more (European) countries and more patient characteristics to determine the degree of representativeness (at the European level).
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Facultair begeleider: and Jong, Corina de PhD Locatie: Groningen Research Institute fo |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:52 |
| Last Modified: | 25 Jun 2020 10:52 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1283 |
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