Performance of database-derived severe exacerbations and asthma control measures in asthma: responsiveness and predictive utility in a UK primary care database with linked questionnaire data.
Performance of database-derived severe exacerbations and asthma control measures in asthma: responsiveness and predictive utility in a UK primary care database with linked questionnaire data.
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DOI：
10.2147/por.s151615
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发表时间：
2018
影响因子：
8.9
通讯作者：
Price DB
中科院分区：
文献类型：
--
作者：
Colice G;Chisholm A;Dima AL;Reddel HK;Burden A;Martin RJ;Brusselle G;Popov TA;von Ziegenweidt J;Price DB
观察性研究对于评估哮喘治疗的实际有效性至关重要，现在可以利用来自电子病历的结果。本研究的目的是调查几个数据库结果的措施在哮喘的效用。本研究从英国初级保健数据库-最佳患者护理研究数据库中确定了活动性哮喘患者队列，其中约10%前瞻性补充了问卷数据。“问卷队列”包括年龄在18-60岁、具有有效问卷数据和1年连续初级保健数据的患者。单独的“ICS启动”和“ICS递增”队列包括5-60岁开始吸入性皮质类固醇（ICS）治疗的患者，这些患者在该索引访视前后有1年的连续初级保健数据。在最佳患者护理研究数据库中确定了哮喘症状控制和急性发作的数据库指标，并与相应的患者报告（问卷）数据交叉制表。在ICS启动队列中，使用McNemar和Wilcoxon符号秩检验分析数据库结局的反应性，并使用Poisson回归估计数据库结局与未来数据库加重风险之间的相关性。最终研究包括2，366例问卷队列患者和51，404例ICS启动患者。患者报告的病情加重与数据库记录的病情加重之间的一致性较好（kappa 0.35）。在开始ICS治疗后，数据库风险域哮喘控制（基于急性发作）得到改善（哮喘不受控制的患者比例从24.9%降至18.6%; P<0.001），数据库急性发作的平均次数从每例患者每年0.09次降至0.08次（P=0.001）。然而，另一项哮喘控制措施（包括短效β受体激动剂处方作为定义的一部分）并未显示出这种改善。既往有急性加重的患者未来急性加重的风险更高（率比[95%置信区间]，3.23 [3.03-3.57]）。除短效β受体激动剂处方外，来自初级保健数据库的哮喘控制和急性发作均有效，并可用于风险预测。
Observational research is essential to evaluate the real-life effectiveness of asthma treatments and can now make use of outcomes derived from electronic medical records. The aim of this study was to investigate the utility of several database outcome measures in asthma. This study identified cohorts of patients with active asthma from a UK primary care database – Optimum Patient Care Research Database – approximately 10% of which was prospectively supplemented with questionnaire data. The “Questionnaire cohort” included patients aged 18–60 years with valid questionnaire data and 1 year of continuous primary care data. Separate “ICS initiation” and “ICS step-up” cohorts included patients aged 5–60 years initiated on inhaled corticosteroids (ICSs), who had 1 year of continuous primary care data before, and after, this index visit. Database measures of asthma symptom control and exacerbations were identified in the Optimum Patient Care Research Database and cross-tabulated with corresponding patient-reported (questionnaire) data. Responsiveness of the database outcomes was analyzed, using McNemar’s and Wilcoxon’s signed rank tests, and Poisson regression was used to estimate the association between database outcomes and future risk of database exacerbations, in the ICS initiation cohort. The final study included 2,366 Questionnaire cohort patients and 51,404 ICS initiation patients. Agreement between patient-reported and database-recorded exacerbations was fair (kappa 0.35). Following the initiation of ICS, database risk domain asthma control (based on exacerbations) improved (proportion of patients with uncontrolled asthma decreased from 24.9% to 18.6%; P<0.001) and mean number of database exacerbations decreased from 0.09 to 0.08 per patient per year (P=0.001). However, another measure of asthma control which includes short-acting beta-agonist prescription as part of the definition did not show this improvement. Patients with prior exacerbations had a higher risk of future exacerbation (rate ratio [95% confidence interval], 3.23 [3.03–3.57]). Asthma control and exacerbations derived from primary care databases were responsive, with the exception of short-acting beta-agonist prescriptions, and useful for risk prediction.