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Effects of pulmonary rehabilitation on exacerbation number and severity in people with COPD: An historical cohort study using electronic health records

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Title: Effects of pulmonary rehabilitation on exacerbation number and severity in people with COPD: An historical cohort study using electronic health records
Authors: Moore, E
Newson, R
Joshi, M
Palmer, T
Rothnie, K
Singh, S
Majeed, A
Soljak, M
Quint, JK
Item Type: Journal Article
Abstract: Background In previous systematic reviews, predominantly of randomised controlled trials, pulmonary rehabilitation (PR) has been shown to reduce hospital admissions for acute exacerbations of COPD (AECOPD). However, findings have been less consistent for cohort studies. We aimed to compare rates of hospitalized and general practice (GP) treated AECOPD before and after PR. Methods Using anonymised data from the Clinical Practice Research Datalink and Hospital Episode Statistics, hospital admissions and GP visits for AECOPD were compared one year before and after PR in patients referred for PR. Exacerbation rates were also compared between individuals eligible and referred for PR with those eligible and not referred. Results 69,089 (64%) of the COPD patients in the cohort were eligible for PR. Of these, only 6,436 (9.3%) were recorded as having been referred for rehabilitation. 62, 019 (89.8%) were not referred and 634 (0.98%) declined referral. When combining GP and hospital exacerbations, people who were eligible and were referred for PR had a slightly higher but not statistically significant exacerbation rate (2.83 exacerbations/patient-year 95% CI: 2.66, 3.00) than those who were eligible but not referred (2.17 exacerbations/patient-year 95% CI: 2.11, 2.24). Conclusions This study found that less than 10% of patients who were eligible for PR were actually referred. Patients who were eligible and referred for (but not necessarily completed) PR did not have fewer GP visits and hospitalizations for AECOPD in the year after PR compared to those not referred or compared to the year before PR.
Issue Date: 16-May-2017
Date of Acceptance: 1-May-2017
URI: http://hdl.handle.net/10044/1/48404
DOI: https://dx.doi.org/10.1016/j.chest.2017.05.006
ISSN: 1931-3543
Publisher: Elsevier
Start Page: 1188
End Page: 1202
Journal / Book Title: Chest
Volume: 152
Issue: 6
Copyright Statement: © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/
Sponsor/Funder: The Chartered Society of Physiotherapy
Funder's Grant Number: 131105
Keywords: COPD
health data
health records
hospitalization
pulmonary rehabilitation
Adult
Aged
Disease Progression
Electronic Health Records
Female
Follow-Up Studies
General Practice
Humans
Male
Middle Aged
Prognosis
Pulmonary Disease, Chronic Obstructive
Respiratory Therapy
Severity of Illness Index
Survival Rate
Time Factors
United Kingdom
1103 Clinical Sciences
Respiratory System
Publication Status: Published
Appears in Collections:Infectious Disease Epidemiology
National Heart and Lung Institute
Faculty of Medicine
Epidemiology, Public Health and Primary Care



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