Green Michael E, Natajaran Nandini, O'Donnell Denis E, Williamson Tyler, Kotecha Jyoti, Khan Shahriar, Cave Andrew
Centre for Studies in Primary Care, Department of Family Medicine, Queen's University, Kingston, Ont. ; Department of Public Health Sciences, Queen's University, Kingston, Ont.
Department of Family Medicine, Dalhousie University, Halifax, NS.
CMAJ Open. 2015 Jan 13;3(1):E15-22. doi: 10.9778/cmajo.20140040. eCollection 2015 Jan-Mar.
Chronic obstructive pulmonary disease (COPD) is mostly managed within primary care, but there is little Canadian evidence from this setting. This study was undertaken to determine the prevalence of physician-diagnosed COPD in primary care practices, and the degree of comorbidity with other chronic conditions, and to assess patterns of medication prescribing.
The Canadian Primary Care Sentinel Surveillance Network is a national "network of networks" whose member practices use electronic medical records (EMRs). At the time of the study, it included data from 444 physicians from 10 networks in 8 provinces. We conducted an epidemiologic cohort study of all patients who had EMR data collected by the network at the end of 2012. Validated case-finding algorithms were used to identify cases of COPD. We used descriptive statistics and multivariate modelling analyses to calculate the prevalence of COPD, its association with key demographic factors and comorbidities, and patterns of medication prescribing.
The observed prevalence of COPD was 4.0% (10 043/250 346), which represents a population prevalence of 3.4% using age-sex standardization. Comorbidity was common, with prevalence ratios ranging from 1.1 for the presence of a single comorbid condition to 1.9 for 4 or more comorbid conditions. Anticholinergic agents (63%), short- (48%) and long-acting (38%) β-agonists and inhaled corticosteroids (41%) were the most commonly used medications.
The prevalence of physician-diagnosed COPD in Canadian primary care practices was similar to that reported in other practice-based studies at about 3%-4%. Most patients had comorbid conditions and were taking multiple medications. EMR data may be useful to assess both the epidemiology and management of COPD in primary care practices.
慢性阻塞性肺疾病（COPD）大多在初级保健机构中进行管理，但加拿大在这方面的证据较少。本研究旨在确定初级保健机构中医生诊断的COPD患病率、与其他慢性病的合并症程度，并评估药物处方模式。
加拿大初级保健哨点监测网络是一个全国性的“网络联盟”，其成员机构使用电子病历（EMR）。在研究期间，它纳入了来自8个省份10个网络的444名医生的数据。我们对2012年底网络收集了EMR数据的所有患者进行了一项队列研究。使用经过验证的病例发现算法来识别COPD病例。我们使用描述性统计和多变量建模分析来计算COPD的患病率、其与关键人口统计学因素和合并症的关联以及药物处方模式。
观察到的COPD患病率为4.0%（10043/250346），经年龄 - 性别标准化后的人群患病率为3.4%。合并症很常见，单一合并症的患病率比为1.1，4种或更多合并症的患病率比为1.9。抗胆碱能药物（63%）、短效（48%）和长效（38%）β受体激动剂以及吸入性糖皮质激素（41%）是最常用的药物。
在加拿大初级保健机构中，医生诊断的COPD患病率与其他基于机构的研究报告相似，约为3% - 4%。大多数患者有合并症且正在服用多种药物。EMR数据可能有助于评估初级保健机构中COPD的流行病学和管理情况。
