Lia Chatzidiakou

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.

Recruitment of patients with Chronic Obstructive Pulmonary Disease (COPD) from the Clinical Practice Research Datalink (CPRD) for research

Databases of electronic health records (EHR) are not only a valuable source of data for health research but have also recently been used as a medium through which potential study participants can be screened, located and approached to take part in research. The aim was to assess whether it is feasible and practical to screen, locate and approach patients to take part in research through the Clinical Practice Research Datalink (CPRD). This is a cohort study in primary care. The CPRD anonymised EHR database was searched to screen patients with Chronic Obstructive Pulmonary Disease (COPD) to take part in a research study. The potential participants were contacted via their General Practitioner (GP) who confirmed their eligibility. Eighty two practices across Greater London were invited to the study. Twenty-six (31.7%) practices consented to participate resulting in a pre-screened list of 988 patients. Of these, 632 (63.7%) were confirmed as eligible following the GP review. Two hundred twenty seven (36%) response forms were received by the study team; 79 (34.8%) responded ‘yes’ (i.e., they wanted to be contacted by the research assistant for more information and to talk about enrolling in the study), and 148 (65.2%) declined participation. This study has shown that it is possible to use EHR databases such as CPRD to screen, locate and recruit participants for research. This method provides access to a cohort of patients while minimising input needed by GPs and allows researchers to examine healthcare usage and disease burden in more detail and in real-life settings.Chronic lung disease: Screening for patient participantsScreening anonymized electronic health records could prove a valuable, time-saving method for identifying patient cohorts for research projects. Jennifer Quint at Imperial College, London, and co-workers used primary care databases provided by doctors’ surgeries in London to find suitable patients for a study monitoring daily chronic obstructive pulmonary disease (COPD) symptoms. Using carefully-designed algorithms, the researchers identified 988 COPD patients who met eligibility criteria and lived within defined localities. Quint’s team then asked the patients’ doctors to review and approve the list for their own practice, thus limiting the doctors’ workload for selecting patients. The researchers approached 632 patients to invite them to participate in the research; 66 were enrolled. This provided an adequate number for the study, though the team highlight a need to improve strategies that encourage patients to take part in research.

P I – 3–10 Seasonal contrasts of indoor exposure to pm2.5 in peri-urban and urban beijing

Background/aim Facing high concentrations of ambient air pollution and household air pollution from biomass burning, Beijing is introducing interventions on fuel for domestic heating in its strategy package. My study aims to: understand the indoor exposure to PM2.5 in peri-urban and urban Beijing during winter and summer, understand the causes of seasonal and spatial differences in indoor exposure levels. Methods The Effects of AIR pollution on cardiopuLmonary disEaSe in urban and peri-urban reSidents in Beijing (AIRLESS) study, is a collaborative research project between UK and China to understand the health effects of air pollution in peri-urban and urban Beijing. During AIRLESS winter and summer campaigns, indoor deployment sub-panels were recruited out of the AIRLESS panels in peri-urban and urban Beijing. Urban sub-panel members were selected considering the floor of residence and distance to the main road; the selection criteria of the peri-urban sub-panel were: home exposure to environmental tobacco smoke (ETS), fuel used for cooking and fuel used for heating. RTI MicroPEM V3.2 nephelometer was deployed indoor to monitor PM2.5 continuously for at least 48 hours. Results In this project, 25 peri-urban and 25 urban subjects completed more than 48 hour PM2.5 exposure monitoring for both winter and summer campaigns. In both peri-urban and urban sub-panels, there were significantly higher (p<0.01) log-transformed indoor exposure levels in winter than summer. When combining the subjects in the two sites together, the difference is till significant (p<0.01). Currently the effects of fuel types and air purifier on indoor air quality in peri-urban and urban Beijing are being investigated. Conclusion This project shows that there are significant seasonal differences in indoor exposure levels to PM2.5 in AIRLESS peri-urban and urban sub-panels. Investigations will be conducted to analyse the reasons for seasonal and spatial differences, using the fuel, behaviour and air purifier data that were collected. In future, we hope to inform fuel use interventions and behaviour changes in Beijing.

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.