Comparing health status between patients with COPD in primary, secondary and tertiary care

Abstract

In this study, we compare health status between COPD patients treated in three different care levels in the Netherlands and assess determinants that influence their health status. We applied the Nijmegen Clinical Screening Instrument to measure eight health status subdomains in primary (n = 289), secondary (n = 184) and tertiary care (n = 433) COPD patient cohorts. Proportions of patients with severe problems in ≥3 subdomains are 47% in primary, 71% in secondary and 94% in tertiary care. Corrected for patient characteristics, differences between the care levels are statistically significant for nearly all health status subdomains. The pooled cohort data show female sex, age, FEV₁ % predicted and BMI to be determinants of one or more subdomains. We conclude that the proportion of COPD patients with severe health status problems is substantial, not just in tertiary care but also in primary and secondary care. Use of detailed health status information may support patient-tailored COPD care.

Fig. 1. NCSI health status subdomains per care level: distribution of proportions of normal functioning, mild problems and severe problems (%).

a Primary care COPD cohort; b secondary care COPD cohort; c tertiary care COPD cohort. QoL quality of life, HRQOL health−related quality of life, Rel relation, Subimp subjective impairment, Behimp behavioural impairment, Subcom subjective symptoms, Dysemo dyspnoea emotions, Fat fatigue, NCSI Nijmegen Clinical Screening Instrument.

Fig. 2. Distribution of percentages of patients with severe problems in the number of subdomains of health status as measured by the NCSI, per care level.

NCSI Nijmegen Clinical Screening Instrument.