Elizabeth Moore

Effects of Pulmonary Rehabilitation on Exacerbation Number and Severity in People With COPD: An Historical Cohort Study Using Electronic Health Records

BACKGROUND: In previous systematic reviews (predominantly of randomized controlled trials), pulmonary rehabilitation (PR) has been shown to reduce hospital admissions for acute exacerbations of COPD (AECOPD). However, findings have been less consistent for cohort studies. The goal of this study was to compare rates of hospitalized and general practice (GP)‐treated AECOPD prior to and following PR. METHODS: Using anonymized data from the Clinical Practice Research Datalink and Hospital Episode Statistics, hospital admissions and GP visits for AECOPD were compared 1 year prior to and 1 year following PR in patients referred for PR. Exacerbation rates were also compared between individuals eligible and referred for PR vs those eligible and not referred. RESULTS: A total of 69,089 (64%) of the patients with COPD in the cohort were eligible for PR. Of these, only 6,436 (9.3%) were recorded as having been referred for rehabilitation. A total of 62,019 (89.8%) were not referred, and 634 (0.98%) declined referral. When combining GP and hospital exacerbations, patients who were eligible and referred for PR had a slightly higher but not statistically significant exacerbation rate (2.83 exacerbations/patient‐year; 95% CI, 2.66–3.00) than those who were eligible but not referred (2.17 exacerbations/patient‐year; 95% CI, 2.11–2.24). CONCLUSIONS: This study found that < 10% of patients who were eligible for PR were actually referred. Patients who were eligible and referred for (but not necessarily completed) PR did not have fewer GP visits and hospitalizations for AECOPD in the year following PR compared with those not referred or compared with the year prior to PR.

Linking e-health records, patient-reported symptoms and environmental exposure data to characterise and model COPD exacerbations: protocol for the COPE study

Introduction Relationships between exacerbations of chronic obstructive pulmonary disease (COPD) and environmental factors such as temperature, humidity and air pollution are not well characterised, due in part to oversimplification in the assignment of exposure estimates to individuals and populations. New developments in miniature environmental sensors mean that patients can now carry a personal air quality monitor for long periods of time as they go about their daily lives. This creates the potential for capturing a direct link between individual activities, environmental exposures and the health of patients with COPD. Direct associations then have the potential to be scaled up to population levels and tested using advanced human exposure models linked to electronic health records. Methods and analysis This study has 5 stages: (1) development and deployment of personal air monitors; (2) recruitment and monitoring of a cohort of 160 patients with COPD for up to 6 months with recruitment of participants through the Clinical Practice Research Datalink (CPRD); (3) statistical associations between personal exposure with COPD-related health outcomes; (4) validation of a time-activity exposure model and (5) development of a COPD prediction model for London. Ethics and dissemination The Research Ethics Committee for Camden and Islington has provided ethical approval for the conduct of the study. Approval has also been granted by National Health Service (NHS) Research and Development and the Independent Scientific Advisory Committee. The results of the study will be disseminated through appropriate conference presentations and peer-reviewed journals.

Prognostic variables and scores identifying the end of life in COPD: a systematic review

Introduction COPD is a major cause of mortality, and the unpredictable trajectory of the disease can bring challenges to end-of-life care. We aimed to investigate known prognostic variables and scores that predict prognosis in COPD in a systematic literature review, specifically including variables that contribute to risk assessment of patients for death within 12 months. Methods We conducted a systematic review on prognostic variables, multivariate score or models for COPD. Ovid MEDLINE, EMBASE, the Cochrane database, Cochrane CENTRAL, DARE and CINAHL were searched up to May 1, 2016. Results A total of 5,276 abstracts were screened, leading to 516 full-text reviews, and 10 met the inclusion criteria. No multivariable indices were developed with the specific aim of predicting all-cause mortality in stable COPD within 12 months. Only nine indices were identified from four studies, which had been validated for this time period. Tools developed using expert knowledge were also identified, including the Gold Standards Framework Prognostic Indicator Guidance, the RADboud Indicators of Palliative Care Needs, the Supportive and Palliative Care Indicators Tool and the Necesidades Paliativas program tool. Conclusion A number of variables contributing to the prediction of all-cause mortality in COPD were identified. However, there are very few studies that are designed to assess, or report, the prediction of mortality at or less than 12 months. The quality of evidence remains low, such that no single variable or multivariable score can currently be recommended.

P211 Using the clinical practice research datalink (CPRD) to recruit participants from primary care to investigate chronic obstructive pulmonary disease (COPD) exacerbations

Introduction Traditionally, recruitment for health research involves clinicians identifying and then contacting potentially suitable participants. This can be both time-consuming and labour intensive for clinicians and researchers. Databases of Electronic Healthcare Records (EHRs) can be used as a resource through which potential study participants can be approached but is often underutilised in spite of previously being shown to be effective (Horspool et al, 2013). For a study investigating the association between air pollution and COPD exacerbations using portable air monitors and symptom diaries, we employed a relatively novel method of recruitment involving approaching patients to participate via the Clinical Practice Research Datalink (CPRD), an anonymised general practitioner (GP) records database containing ongoing primary care medical data. Methods Patients registered at general practices within Greater London whose GP practices were part of the CPRD network were identified anonymously by CPRD using a validated codelist and algorithm developed by our team (Quint et al, 2014). GPs were able to verify the suitability of the potential participants identified and post information about the study to them. Patients could register their interest in the study directly with the research team to be enrolled in the study. Results Feasibility screening by CPRD between January and July 2016 indicated 675 potential study participants at 20 practices and from the CPRD-supplied practice screening lists GPs identified and deemed eligible 462 patients. 462 patients were contacted and the response rate was 136/462 of which 43 (32%) were enrolled and 93 (68%) declined. The main reason for declining was related to the demands that the project entailed of looking after the air monitor and diary for 6 months. Conclusion Patients with COPD from GP practices within Greater London were successfully screened and recruited through CPRD to participate in research over a 6 month period thus providing access to a milder cohort of research naive patients who better represent the majority of the COPD population and this method minimised input needed by the GP. This is a novel method of using EHRs to recruit participants for research that is currently underutilised.