The role of primary care in reducing hospital admissions for patients with Chronic Obstructive Pulmonary Disease

BackgroundChronic obstructive pulmonary disease (COPD) is the fourthleading cause of death worldwide; it is the third most commonreason for hospital admission in Scotland. Obtaining evidencefor how interventions in primary care can reduce hospitaladmissions for COPD is important to influence policy andpractice, improve patients’ quality of life and reduce healthcarecosts.
MethodsPrimary care data were extracted from 72 (70%) of 103 eligiblegeneral practices in Lothian, Scotland for patients with COPD,and linked to hospital admissions, spirometry, and mortalitydata. The study included people whose COPD was diagnosedbetween 2000 and 2008 with follow-up until 31st March 2010.A Cox proportional hazards regression model was used todetermine which interventions in primary care were associatedwith delay in hospital admission for exacerbation of COPD.The model included adjustment for age at diagnosis, sex,socio-economic status, disease severity, smoking status, bodymass index, previous admission for COPD, previous interven-tion for respiratory disease, co-morbidities, palliative care,prescriptions of statins and beta blockers.
ResultsThere were 7072 people with COPD in the cohort of whom26% had one or more hospital admissions during 4.4 yearsmean follow-up time. In the adjusted model the followinginterventions were associated with delay or avoidance ofhospitaladmissions:influenzavaccination(HR0.5;95%CI = 0.5-0.6),pneumococcalvaccination(HR0.6;95%CI = 0.6-0.7), annual review (HR 0.3; 95%CI = 0.26-0.33), inhaler check (HR 0.4; 95%CI = 0.3-0.4), confirmationof diagnosis by spirometry (HR 0.5; 95%CI = 0.5-0.6), self-management plan (HR 0.2; 95%CI = 0.1-0.3), record ofsmoking status (HR 0.2; 95%CI = 0.18-0.23) and pulmonaryrehabilitation (HR 0.2; 95%CI = 0.2-0.3). For smokers, recordof smoking cessation advice (HR 0.5; 95%CI = 0.4-0.6) wasassociated with delay or avoidance of hospital admission.
ConclusionsThis unique linked dataset provides evidence for strongassociations between a range of primary care interventionsand delayed or averted admission to hospital for patients withCOPD. Further support should be provided to primary care totarget patients with COPD with these interventions in theanticipation that hospital admissions will reduce.