Nottingham Respiratory Research Unit, NIHR Nottingham BRC, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK.
Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK.
NPJ Prim Care Respir Med. 2017 Oct 11;27(1):58. doi: 10.1038/s41533-017-0058-2.
Pulmonary rehabilitation is recommended for patients with COPD to improve physical function, breathlessness and quality of life. Using The Health Information Network (THIN) primary care database in UK, we compared the demographic and clinical parameters of patients with COPD in relation to coding of pulmonary rehabilitation, and to investigate whether there is a survival benefit from pulmonary rehabilitation. We identified patients with COPD, diagnosed from 2004 and extracted information on demographics, pulmonary rehabilitation and clinical parameters using the relevant Read codes. Thirty six thousand one hundred and eighty nine patients diagnosed with COPD were included with a mean (SD) age of 67 (11) years, 53% were male and only 9.8% had a code related to either being assessed, referred, or completing pulmonary rehabilitation ever. Younger age at diagnosis, better socioeconomic status, worse dyspnoea score, current smoking, and higher comorbidities level are more likely to have a record of pulmonary rehabilitation. Of those with a recorded MRC of 3 or worse, only 2057 (21%) had a code of pulmonary rehabilitation. Survival analysis revealed that patients with coding for pulmonary rehabilitation were 22% (95% CI 0.69-0.88) less likely to die than those who had no coding. In UK THIN records, a substantial proportion of eligible patients with COPD have not had a coded pulmonary rehabilitation record. Survival was improved in those with PR record but coding for other COPD treatments were also better in this group. GP practices need to improve the coding for PR to highlight any unmet need locally.
ROLLING OUT THE REHAB: Analysis of recent UK data suggests that more patients with chronic lung disease could benefit from lung rehabilitation programmes. During pulmonary rehabilitation (PR), patients with chronic obstructive pulmonary disease (COPD) work with specialists to learn exercises and optimise breathing techniques. The programmes are recommended under current guidelines, particularly for patients with a high breathlessness score. Despite this, when Charlotte Bolton and co-workers at the University of Nottingham analysed 36,189 patient primary care records gathered since 2004, they found only 9.8% of COPD patients had ever had a coded record of being assessed, referred for, or undertaken PR. Those patients who completed PR were 22% less likely to die that those who didn't, although appeared they had also received better overall COPD care. Current smokers, those suffering from co-morbidities and younger patients were more likely to receive PR than other patient groups.
肺康复被推荐用于 COPD 患者，以改善其身体机能、呼吸困难和生活质量。我们利用英国的医疗信息网（THIN）初级保健数据库，比较了 COPD 患者的人口统计学和临床参数与肺康复编码的关系，并调查了肺康复是否具有生存获益。我们从 2004 年开始诊断出患有 COPD 的患者，并使用相关的 Read 代码提取了人口统计学、肺康复和临床参数信息。共纳入 36189 例 COPD 患者，平均（标准差）年龄为 67（11）岁，53%为男性，仅有 9.8%的患者有过评估、转诊或完成肺康复的记录。较年轻的诊断年龄、较好的社会经济地位、较差的呼吸困难评分、当前吸烟和更高的合并症水平更有可能有肺康复记录。在那些记录 MRC 为 3 或更差的患者中，仅有 2057 例（21%）有肺康复的记录。生存分析显示，有肺康复编码的患者死亡的可能性比没有编码的患者低 22%（95%CI 0.69-0.88）。在英国 THIN 记录中，相当一部分符合条件的 COPD 患者没有肺康复记录。有 PR 记录的患者的生存率得到了改善，但该组中其他 COPD 治疗的编码也更好。全科医生需要改进 PR 的编码，以突出当地未满足的需求。
推广康复：最近英国的数据分析表明，更多的慢性肺部疾病患者可能受益于肺康复计划。在肺康复（PR）期间，慢性阻塞性肺疾病（COPD）患者与专家合作，学习运动和优化呼吸技术。根据当前指南，这些方案是推荐的，特别是对于呼吸困难评分较高的患者。尽管如此，当诺丁汉大学的夏洛特·博尔顿（Charlotte Bolton）及其同事分析 2004 年以来收集的 36189 名患者的初级保健记录时，他们发现只有 9.8%的 COPD 患者有过评估、转诊或接受 PR 的记录。完成 PR 的患者死亡的可能性比未完成的患者低 22%，尽管他们似乎也接受了更好的 COPD 整体治疗。目前吸烟、患有合并症和较年轻的患者比其他患者群体更有可能接受 PR。
