Low uptake of palliative care for COPD patients within primary care in the UK.
Low uptake of palliative care for COPD patients within primary care in the UK.
复制标题
DOI：
10.1183/13993003.01879-2017
复制
发表时间：
2018-03
期刊：
影响因子：
--
通讯作者：
Quint JK
中科院分区：
文献类型：
--
作者：
Bloom CI;Slaich B;Morales DR;Smeeth L;Stone P;Quint JK
慢性阻塞性肺疾病（COPD）和肺癌的死亡率和症状负担相似，但人们认为疾病之间在姑息治疗支持（PCS）方面存在不平等。这项具有全国代表性的研究评估了英国初级保健中COPD患者的PCS。这是一项使用电子医疗记录（2004-2015）的队列研究。采用logistic回归对整个队列和死亡患者评估与接受PCS相关的因素。共有92 365例符合条件的COPD患者，其中26 135例死亡。整个队列中只有7.8%的患者和21.4%的死亡患者接受了PCS。与其他患者特征相比，肺癌与PCS有很强的相关性，包括慢性阻塞性肺疾病全球倡议分期和医学研究委员会呼吸困难评分（全队列，肺癌：OR 14.1, 95% CI 13.1-15；死亡患者，肺癌：OR 6.5, 95% CI 6-7）。只有16.7%的未患肺癌的已故COPD患者接受了PCS，而肺癌患者的这一比例为56.5%。在接受PCS的患者中，肺癌联合诊断显著增加了生命最后一个月前接受PCS的机会（死亡前1 - 6个月vs≤1个月：风险比1.4,95% CI 1.3-1.7）。在英国，为COPD患者提供PCS是不够的。肺癌，而非COPD，是COPD患者接受PCS的主要驱动因素。在英国，为无肺癌的COPD患者提供姑息治疗的情况很差http://ow.ly/IIC230gWOOV
Mortality and symptom burden from chronic obstructive pulmonary disease (COPD) and lung cancer are similar but there is thought to be an inequality in palliative care support (PCS) between diseases. This nationally representative study assessed PCS for COPD patients within primary care in the UK. This was a cohort study using electronic healthcare records (2004–2015). Factors associated with receiving PCS were assessed using logistic regression for the whole cohort and deceased patients. There were 92 365 eligible COPD patients, of which 26 135 died. Only 7.8% of the whole cohort and 21.4% of deceased patients received PCS. Lung cancer had a strong association with PCS compared with other patient characteristics, including Global Initiative for Chronic Obstructive Lung Disease stage and Medical Research Council Dyspnoea score (whole cohort, lung cancer: OR 14.1, 95% CI 13.1–15; deceased patients, lung cancer: OR 6.5, 95% CI 6–7). Only 16.7% of deceased COPD patients without lung cancer received PCS compared with 56.5% of deceased patients with lung cancer. In patients that received PCS, lung cancer co-diagnosis significantly increased the chances of receiving PCS before the last month of life (1–6 versus ≤1 month pre-death: risk ratio 1.4, 95% CI 1.3–1.7). Provision of PCS for COPD patients in the UK is inadequate. Lung cancer, not COPD, was the dominant driver for COPD patients to receive PCS. Palliative care provision for COPD patients without lung cancer is poor in the UK http://ow.ly/IIC230gWOOV
登录
查看更多内容
影响因子：
3.1
作者：
Gomes B;Calanzani N;Gysels M;Hall S;Higginson IJ
通讯作者：
Higginson IJ
影响因子：
9.6
作者：
Rush, Barret;Hertz, Paul;Celi, Leo Anthony
通讯作者：
Celi, Leo Anthony
影响因子：
9.6
作者：
Knauft, E;Nielsen, EL;Curtis, JR
通讯作者：
Curtis, JR
医学研究委员会（MRC）呼吸困难量表作为慢性阻塞性肺病患者残疾度量标准的实用性
影响因子：
10
作者：
Bestall, JC;Paul, EA;Wedzicha, JA
通讯作者：
Wedzicha, JA
影响因子：
3.1
作者：
Cohen, Joachim;Beernaert, Kim;Houttekier, Dirk
通讯作者：
Houttekier, Dirk