title: Improvement in COPD management by access to asthma/COPD clinics in primary care: data from the observational PATHOS study.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) guidelines emphasize the importance of patient education to improve quality of life and avoid exacerbations. Longitudinal evaluations of structured management of COPD in primary care are lacking.
  
  
  OBJECTIVE
  To evaluate the impact of primary care asthma/COPD clinics on exacerbations, hospitalizations, and associated costs in COPD.
  
  
  METHODS
  This population-based, retrospective, observational study, linking primary care medical records data to mandatory Swedish national registries, included patients with COPD from 76 primary healthcare centers (1999-2009). A questionnaire on access to an asthma/COPD clinic was retrospectively answered. Propensity score matching was performed at index (COPD diagnosis) by center type (with and without an asthma/COPD clinic). Poisson regression was used to compare the yearly rate of exacerbations (hospitalization, emergency visits, or prescription for oral steroids or antibiotics) and COPD-related prescriptions at the centers. An economic analysis was performed from the Swedish healthcare perspective using 2011 unit costs and the incremental cost-effectiveness ratio was calculated.
  
  
  RESULTS
  The study included 21,361 patients (mean age, 68.0 years; 53% female). Access to asthma/COPD clinics increased from 34% to 85% during the study period. Patients at primary healthcare centers with asthma/COPD clinics had 27% fewer exacerbations (0.71 vs. 0.98) and 37% fewer hospitalizations annually (0.36 vs. 0.58) (p < 0.0001). Asthma/COPD clinics reduced the annual cost of medication and healthcare contacts by 37% (SEK 52,892 [€5858] to SEK 33,410 [€3700] per patient).
  
  
  CONCLUSIONS
  Patients at primary healthcare centers with asthma/COPD clinics experienced fewer COPD exacerbations and hospitalizations, and overall treatment costs were substantially reduced. ClinicalTrials.gov identifier: NCT01146392.
authors.affiliation: Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, BMC, Box 564, SE-751 22 Uppsala, Sweden. Electronic address: karin.lisspers@ltdalarna.se.
authors.forename: Karin
authors.initials: K
authors.lastname: Lisspers
authors.affiliation: Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, BMC, Box 564, SE-751 22 Uppsala, Sweden.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Johansson
authors.affiliation: Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Akademiska sjukhuset, SE-751 85 Uppsala, Sweden.
authors.forename: Christer
authors.initials: C
authors.lastname: Jansson
authors.affiliation: Unit of Lung and Allergy Research, National Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden.
authors.forename: Kjell
authors.initials: K
authors.lastname: Larsson
authors.affiliation: AstraZeneca Nordic-Baltic, SE-151 85 Södertälje, Sweden.
authors.forename: Georgios
authors.initials: G
authors.lastname: Stratelis
authors.affiliation: Formerly AstraZeneca Nordic-Baltic, DK-2300 Copenhagen S, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Hedegaard
authors.affiliation: Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, BMC, Box 564, SE-751 22 Uppsala, Sweden.
authors.forename: Björn
authors.initials: B
authors.lastname: Ställberg
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities / Q000191:economics / Q000458:organization & administration*; D001249:Asthma / Q000628:therapy; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000458:organization & administration*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008498:Medical Record Linkage; D008875:Middle Aged; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration*; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D058996:Quality Improvement / Q000458:organization & administration; D012189:Retrospective Studies; D013548:Sweden / Q000453:epidemiology
keywords: Asthma/COPD clinic; COPD; Cost-effectiveness analysis; Exacerbations; Healthcare costs