Association of population and primary healthcare factors with hospital admission rates for chronic obstructive pulmonary disease in England: national cross-sectional study
BackgroundHospital admission rates for chronic obstructive pulmonary disease (COPD) are known to be strongly associated with population factors. Primary care services may also affect admission rates, but there is little direct supporting evidence.ObjectivesTo determine associations between populatio...
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| Veröffentlicht in: | Thorax 2011-03, Vol.66 (3), p.191-196 |
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| creator | Calderón-Larrañaga, Amaia Carney, Leanne Soljak, Michael Bottle, Alex Partridge, Martyn Bell, Derek Abi-Aad, Gerrard Aylin, Paul Majeed, Azeem |
| description | BackgroundHospital admission rates for chronic obstructive pulmonary disease (COPD) are known to be strongly associated with population factors. Primary care services may also affect admission rates, but there is little direct supporting evidence.ObjectivesTo determine associations between population characteristics, diagnosed and undiagnosed COPD prevalence, primary healthcare factors, and COPD admission rates primary care trust (PCT) and general practice levels in England.Design, setting, and participantsNational cross-sectional study (53,676,051 patients in 8,064 practices in 152 English PCTs), combining data on hospital admissions, populations, primary healthcare staffing, clinical practice quality and access, and prevalence.Main outcome measuresDirectly and indirectly standardised hospital admission rates for COPD, for PCT and practice populations.ResultsMean annual COPD admission rates per 100 000 population varied from 124.7 to 646.5 for PCTs and 0.0 to 2175.2 for practices. Admissions were strongly associated with population deprivation at both levels. In a practice-level multivariate Poisson regression, registered and undiagnosed COPD prevalence, smoking prevalence and deprivation were risk factors for admission (p |
| doi_str_mv | 10.1136/thx.2010.147058 |
| format | Article |
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Primary care services may also affect admission rates, but there is little direct supporting evidence.ObjectivesTo determine associations between population characteristics, diagnosed and undiagnosed COPD prevalence, primary healthcare factors, and COPD admission rates primary care trust (PCT) and general practice levels in England.Design, setting, and participantsNational cross-sectional study (53,676,051 patients in 8,064 practices in 152 English PCTs), combining data on hospital admissions, populations, primary healthcare staffing, clinical practice quality and access, and prevalence.Main outcome measuresDirectly and indirectly standardised hospital admission rates for COPD, for PCT and practice populations.ResultsMean annual COPD admission rates per 100 000 population varied from 124.7 to 646.5 for PCTs and 0.0 to 2175.2 for practices. Admissions were strongly associated with population deprivation at both levels. In a practice-level multivariate Poisson regression, registered and undiagnosed COPD prevalence, smoking prevalence and deprivation were risk factors for admission (p<0.001), while healthcare factors- influenza immunisation, patient-reported access to consultations within two days, and primary care staffing, were protective (p<0.05).ConclusionAssociations of COPD admission rates with deprivation, primary healthcare access and supply highlight the need for adequate services in deprived areas. An association between admission rates and undiagnosed COPD prevalence suggests that case-finding strategies should be evaluated. Of the COPD clinical quality indicators, only influenza immunisation was associated with reduced admission rates. Patients' experience of access to primary care may also be clinically important.</description><identifier>ISSN: 0040-6376</identifier><identifier>EISSN: 1468-3296</identifier><identifier>DOI: 10.1136/thx.2010.147058</identifier><identifier>PMID: 21076143</identifier><identifier>CODEN: THORA7</identifier><language>eng</language><publisher>London: BMJ Publishing Group Ltd and British Thoracic Society</publisher><subject><![CDATA[access ; Adolescent ; Adult ; Aged ; and evaluation ; Biological and medical sciences ; Cardiology. Vascular system ; Chronic illnesses ; chronic obstructive ; Chronic obstructive pulmonary disease ; Chronic obstructive pulmonary disease, asthma ; clinical epidemiology ; COPD epidemiology ; Data processing ; England - epidemiology ; Epidemiologic Methods ; Family Practice - organization & administration ; Female ; Health care access ; Health Services Accessibility - statistics & numerical data ; Health Services Research - methods ; healthcare quality ; Hospitalization - statistics & numerical data ; Hospitals ; Humans ; Immunization ; Influenza ; Inhalers ; Male ; Medical sciences ; Middle Aged ; Patient admissions ; Pneumology ; Poverty - statistics & numerical data ; Primary care ; Primary Health Care - organization & administration ; primary healthcare ; Pulmonary disease ; Pulmonary Disease, Chronic Obstructive - epidemiology ; Pulmonary Disease, Chronic Obstructive - etiology ; Pulmonary Disease, Chronic Obstructive - therapy ; Risk factors ; Smoking ; Smoking - adverse effects ; Smoking - epidemiology ; Smoking cessation ; State Medicine - organization & administration ; utilisation ; Young Adult]]></subject><ispartof>Thorax, 2011-03, Vol.66 (3), p.191-196</ispartof><rights>2011, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright: 2011 (c) 2011, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b501t-7a85565c6ccbc619be51921c09ecf90409490cf77d6b0ffe4cbad17e8739df453</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://thorax.bmj.com/content/66/3/191.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttps://thorax.bmj.com/content/66/3/191.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>114,115,314,776,780,3183,23550,27901,27902,77343,77374</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23900468$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21076143$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Calderón-Larrañaga, Amaia</creatorcontrib><creatorcontrib>Carney, Leanne</creatorcontrib><creatorcontrib>Soljak, Michael</creatorcontrib><creatorcontrib>Bottle, Alex</creatorcontrib><creatorcontrib>Partridge, Martyn</creatorcontrib><creatorcontrib>Bell, Derek</creatorcontrib><creatorcontrib>Abi-Aad, Gerrard</creatorcontrib><creatorcontrib>Aylin, Paul</creatorcontrib><creatorcontrib>Majeed, Azeem</creatorcontrib><title>Association of population and primary healthcare factors with hospital admission rates for chronic obstructive pulmonary disease in England: national cross-sectional study</title><title>Thorax</title><addtitle>Thorax</addtitle><description>BackgroundHospital admission rates for chronic obstructive pulmonary disease (COPD) are known to be strongly associated with population factors. Primary care services may also affect admission rates, but there is little direct supporting evidence.ObjectivesTo determine associations between population characteristics, diagnosed and undiagnosed COPD prevalence, primary healthcare factors, and COPD admission rates primary care trust (PCT) and general practice levels in England.Design, setting, and participantsNational cross-sectional study (53,676,051 patients in 8,064 practices in 152 English PCTs), combining data on hospital admissions, populations, primary healthcare staffing, clinical practice quality and access, and prevalence.Main outcome measuresDirectly and indirectly standardised hospital admission rates for COPD, for PCT and practice populations.ResultsMean annual COPD admission rates per 100 000 population varied from 124.7 to 646.5 for PCTs and 0.0 to 2175.2 for practices. Admissions were strongly associated with population deprivation at both levels. In a practice-level multivariate Poisson regression, registered and undiagnosed COPD prevalence, smoking prevalence and deprivation were risk factors for admission (p<0.001), while healthcare factors- influenza immunisation, patient-reported access to consultations within two days, and primary care staffing, were protective (p<0.05).ConclusionAssociations of COPD admission rates with deprivation, primary healthcare access and supply highlight the need for adequate services in deprived areas. An association between admission rates and undiagnosed COPD prevalence suggests that case-finding strategies should be evaluated. Of the COPD clinical quality indicators, only influenza immunisation was associated with reduced admission rates. Patients' experience of access to primary care may also be clinically important.</description><subject>access</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>and evaluation</subject><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Chronic illnesses</subject><subject>chronic obstructive</subject><subject>Chronic obstructive pulmonary disease</subject><subject>Chronic obstructive pulmonary disease, asthma</subject><subject>clinical epidemiology</subject><subject>COPD epidemiology</subject><subject>Data processing</subject><subject>England - epidemiology</subject><subject>Epidemiologic Methods</subject><subject>Family Practice - organization & administration</subject><subject>Female</subject><subject>Health care access</subject><subject>Health Services Accessibility - statistics & numerical data</subject><subject>Health Services Research - methods</subject><subject>healthcare quality</subject><subject>Hospitalization - statistics & numerical data</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Immunization</subject><subject>Influenza</subject><subject>Inhalers</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Patient admissions</subject><subject>Pneumology</subject><subject>Poverty - statistics & numerical data</subject><subject>Primary care</subject><subject>Primary Health Care - organization & administration</subject><subject>primary healthcare</subject><subject>Pulmonary disease</subject><subject>Pulmonary Disease, Chronic Obstructive - epidemiology</subject><subject>Pulmonary Disease, Chronic Obstructive - etiology</subject><subject>Pulmonary Disease, Chronic Obstructive - therapy</subject><subject>Risk factors</subject><subject>Smoking</subject><subject>Smoking - adverse effects</subject><subject>Smoking - epidemiology</subject><subject>Smoking cessation</subject><subject>State Medicine - organization & administration</subject><subject>utilisation</subject><subject>Young Adult</subject><issn>0040-6376</issn><issn>1468-3296</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqFks1u1TAQhSMEopfCmh2yhBCoUlo7TuyEXYlKQVSwALq1HMcmviRx8DjQPhMvidOEIrGAlTXyN2d-ziTJY4KPCaHsJHRXxxleopzjoryT7EjOypRmFbub7DDOccooZwfJA4A9xrgkhN9PDjKCOSM53SU_TwGcsjJYNyJn0OSmuV8jObZo8naQ_hp1WvahU9JrZKQKzgP6YUOHOgeTDbJHsh0swJLmZdCAjPNIdd6NViHXQPCzCva7RlF9cOMi2VrQEjSyIzobv_Sx2ks03lSOcso7gBS02mIIc3v9MLlnZA_60fYeJp9fn32q36QXH87f1qcXaVNgElIuy6JghWJKNYqRqtEFqTKicKWVqeJKqrzCynDesgYbo3PVyJZwXXJatSYv6GHyfNWdvPs2awgizqZ0H3vUbgZRFjTLWFx_JF_8kySY8KrMC04i-vQvdO9mH2eLFC9JmdGS0kidrNTNArw2YnMgSonFcREdF4vjYnU8ZjzZdOdm0O0t_9viCDzbAAlK9sbLUVn4w9EqnglbhNKVsxD01e2_9F8F45QX4v1lLT7WNXv1jmTiMvJHK98M-_92-QueA9Q4</recordid><startdate>20110301</startdate><enddate>20110301</enddate><creator>Calderón-Larrañaga, Amaia</creator><creator>Carney, Leanne</creator><creator>Soljak, Michael</creator><creator>Bottle, Alex</creator><creator>Partridge, Martyn</creator><creator>Bell, Derek</creator><creator>Abi-Aad, Gerrard</creator><creator>Aylin, Paul</creator><creator>Majeed, Azeem</creator><general>BMJ Publishing Group Ltd and British Thoracic Society</general><general>BMJ Publishing Group</general><general>BMJ Publishing Group LTD</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7U7</scope><scope>C1K</scope><scope>7X8</scope></search><sort><creationdate>20110301</creationdate><title>Association of population and primary healthcare factors with hospital admission rates for chronic obstructive pulmonary disease in England: national cross-sectional study</title><author>Calderón-Larrañaga, Amaia ; Carney, Leanne ; Soljak, Michael ; Bottle, Alex ; Partridge, Martyn ; Bell, Derek ; Abi-Aad, Gerrard ; Aylin, Paul ; Majeed, Azeem</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b501t-7a85565c6ccbc619be51921c09ecf90409490cf77d6b0ffe4cbad17e8739df453</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>access</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>and evaluation</topic><topic>Biological and medical sciences</topic><topic>Cardiology. Vascular system</topic><topic>Chronic illnesses</topic><topic>chronic obstructive</topic><topic>Chronic obstructive pulmonary disease</topic><topic>Chronic obstructive pulmonary disease, asthma</topic><topic>clinical epidemiology</topic><topic>COPD epidemiology</topic><topic>Data processing</topic><topic>England - epidemiology</topic><topic>Epidemiologic Methods</topic><topic>Family Practice - organization & administration</topic><topic>Female</topic><topic>Health care access</topic><topic>Health Services Accessibility - statistics & numerical data</topic><topic>Health Services Research - methods</topic><topic>healthcare quality</topic><topic>Hospitalization - statistics & numerical data</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Immunization</topic><topic>Influenza</topic><topic>Inhalers</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Patient admissions</topic><topic>Pneumology</topic><topic>Poverty - statistics & numerical data</topic><topic>Primary care</topic><topic>Primary Health Care - organization & administration</topic><topic>primary healthcare</topic><topic>Pulmonary disease</topic><topic>Pulmonary Disease, Chronic Obstructive - epidemiology</topic><topic>Pulmonary Disease, Chronic Obstructive - etiology</topic><topic>Pulmonary Disease, Chronic Obstructive - therapy</topic><topic>Risk factors</topic><topic>Smoking</topic><topic>Smoking - adverse effects</topic><topic>Smoking - epidemiology</topic><topic>Smoking cessation</topic><topic>State Medicine - organization & administration</topic><topic>utilisation</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Calderón-Larrañaga, Amaia</creatorcontrib><creatorcontrib>Carney, Leanne</creatorcontrib><creatorcontrib>Soljak, Michael</creatorcontrib><creatorcontrib>Bottle, Alex</creatorcontrib><creatorcontrib>Partridge, Martyn</creatorcontrib><creatorcontrib>Bell, Derek</creatorcontrib><creatorcontrib>Abi-Aad, Gerrard</creatorcontrib><creatorcontrib>Aylin, Paul</creatorcontrib><creatorcontrib>Majeed, Azeem</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>MEDLINE - Academic</collection><jtitle>Thorax</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Calderón-Larrañaga, Amaia</au><au>Carney, Leanne</au><au>Soljak, Michael</au><au>Bottle, Alex</au><au>Partridge, Martyn</au><au>Bell, Derek</au><au>Abi-Aad, Gerrard</au><au>Aylin, Paul</au><au>Majeed, Azeem</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association of population and primary healthcare factors with hospital admission rates for chronic obstructive pulmonary disease in England: national cross-sectional study</atitle><jtitle>Thorax</jtitle><addtitle>Thorax</addtitle><date>2011-03-01</date><risdate>2011</risdate><volume>66</volume><issue>3</issue><spage>191</spage><epage>196</epage><pages>191-196</pages><issn>0040-6376</issn><eissn>1468-3296</eissn><coden>THORA7</coden><abstract>BackgroundHospital admission rates for chronic obstructive pulmonary disease (COPD) are known to be strongly associated with population factors. Primary care services may also affect admission rates, but there is little direct supporting evidence.ObjectivesTo determine associations between population characteristics, diagnosed and undiagnosed COPD prevalence, primary healthcare factors, and COPD admission rates primary care trust (PCT) and general practice levels in England.Design, setting, and participantsNational cross-sectional study (53,676,051 patients in 8,064 practices in 152 English PCTs), combining data on hospital admissions, populations, primary healthcare staffing, clinical practice quality and access, and prevalence.Main outcome measuresDirectly and indirectly standardised hospital admission rates for COPD, for PCT and practice populations.ResultsMean annual COPD admission rates per 100 000 population varied from 124.7 to 646.5 for PCTs and 0.0 to 2175.2 for practices. Admissions were strongly associated with population deprivation at both levels. In a practice-level multivariate Poisson regression, registered and undiagnosed COPD prevalence, smoking prevalence and deprivation were risk factors for admission (p<0.001), while healthcare factors- influenza immunisation, patient-reported access to consultations within two days, and primary care staffing, were protective (p<0.05).ConclusionAssociations of COPD admission rates with deprivation, primary healthcare access and supply highlight the need for adequate services in deprived areas. An association between admission rates and undiagnosed COPD prevalence suggests that case-finding strategies should be evaluated. Of the COPD clinical quality indicators, only influenza immunisation was associated with reduced admission rates. Patients' experience of access to primary care may also be clinically important.</abstract><cop>London</cop><pub>BMJ Publishing Group Ltd and British Thoracic Society</pub><pmid>21076143</pmid><doi>10.1136/thx.2010.147058</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | access Adolescent Adult Aged and evaluation Biological and medical sciences Cardiology. Vascular system Chronic illnesses chronic obstructive Chronic obstructive pulmonary disease Chronic obstructive pulmonary disease, asthma clinical epidemiology COPD epidemiology Data processing England - epidemiology Epidemiologic Methods Family Practice - organization & administration Female Health care access Health Services Accessibility - statistics & numerical data Health Services Research - methods healthcare quality Hospitalization - statistics & numerical data Hospitals Humans Immunization Influenza Inhalers Male Medical sciences Middle Aged Patient admissions Pneumology Poverty - statistics & numerical data Primary care Primary Health Care - organization & administration primary healthcare Pulmonary disease Pulmonary Disease, Chronic Obstructive - epidemiology Pulmonary Disease, Chronic Obstructive - etiology Pulmonary Disease, Chronic Obstructive - therapy Risk factors Smoking Smoking - adverse effects Smoking - epidemiology Smoking cessation State Medicine - organization & administration utilisation Young Adult |
| title | Association of population and primary healthcare factors with hospital admission rates for chronic obstructive pulmonary disease in England: national cross-sectional study |
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