Quantification of variations in outcomes of respiratory care in Wessex: three COPD projects using the Hampshire Health Record

Theme 1

Integrated Respiratory Care

Research aims and questions

To use the Hampshire Health Record Analytical database (HHRA) to study variation in health care provision and outcomes for patients with COPD in Hampshire.

 

·      Examine the effects of deprivation and co-morbidities  on uptake of healthcare (e.g. smoking-cessation support, vaccination, use of management plans) and outcomes (exacerbations, unscheduled hospital attendances or admissions, mortality)

·      Study the sub-set of patients in whom lung function tests do not support their coded diagnosis of COPD, who may have other causes for their symptoms and may be receiving inappropriate treatment

·      Identify and characterise COPD patients suffering episodes of pneumonia, examine the relationship with use of inhaled corticosteroids, with the aim of highlighting patients in whom corticosteroid prescribing might be associated with greater risk than benefit.

Start date: 31 April 2014

End date: 31 August 2018

 

Outputs: publications:

 

Improved outcomes in ex-smokers with COPD: a UK primary care observational cohort study https://erj.ersjournals.com/content/49/5/1602114.long

 

Impacts

 

·      Improved outcomes in ex-smokers with COPD: a UK primary care observational cohort study. It shows a 17-22% reduction in the risk of death and respiratory-cause hospitalisation in ex-smokers compared to active smokers.

 

·      The relationship between BMI and COPD outcomes. The analyses have shown that being underweight is associated with poor prognosis, but obese and very obese patients paradoxically have a reduced mortality and hospitalisation. The analyses are complete and the 2nd draft of the paper is being revised at the moment. 

 

·      Absent airflow obstruction (AFO) has been found in 15% of our large COPD cohort, suggesting that these patients may be misdiagnosed with COPD. So far, we have characterised the 16479 patients and categorised them according to whether they have evidence of AFO; we are about to analyse outcomes (mortality, hospitalisation) and compare outcomes in the various categories and then look at treatment (to highlight possibly inappropriate treatment in those without AFO). This project is especially important from a clinical prospective. Statistical analysis ongoing, 

 

·      Analyses of comorbidities in our cohort have shown that generally comorbidities are associated with worse outcomes. However, gastro-oesophageal reflux (GORD) is associated with reduced mortality risk. This might be due to treatment and some drugs may have anti-inflammatory properties that benefit COPD. The coding of relevant medications has been completed. 


Back to theme >Contact us

Dr David Culliford

Dr Lynn Josephs

Matt Johnson

Professor Mike Thomas


Hampshire Hospitals NHS Foundation Trust

Health Education Wessex

Isle of Wight NHS Primary Care NHS Trust

NHS Fareham and Gosport CCG

NHS Isle of Wight CCG

NHS North East Hampshire and Farnham CCG

NHS North Hampshire CCG

NHS Portsmouth CCG

NHS South Eastern Hampshire CCG

NHS Southampton City CCG

NHS West Hampshire CCG

Portsmouth Hospitals NHS Trust

Solent NHS Trust

Southern Health NHS Foundation Trust

University Hospital Southampton NHS Foundation Trust

University of Southampton


CLAHRC COPD Summary

Improved outcomes in ex-smokers with COPD: a UK primary care observational cohort study