title: Burden of COPD in patients treated in different care settings in the Netherlands.
abstract: Care for patients with chronic obstructive pulmonary disease (COPD) can be provided in primary, secondary or tertiary care. Whether and to what extent patients with COPD treated in various healthcare settings differ in disease burden and healthcare utilization remains unknown. Therefore, daily symptoms, functional mobility, mood status, health status and healthcare utilization were compared between COPD patients in various care settings, to explore possibilities for healthcare-optimization.
  
  
  
  Current data are part of the Chance study. Demographics, functional mobility (Care Dependency Scale (CDS); Timed-Up-and-Go (TUG) test), mood status (Hospital Anxiety and Depression scale (HADS)), health status (COPD Assessment test (CAT); Clinical COPD questionnaire (CCQ); COPD specific St. George Respiratory questionnaire (SGRQ-C)), received treatments and severity of physical and psychological symptoms were assessed in subjects with and without COPD.
  
  
  
  836 subjects (100 primary care patients, 100 secondary care patients, 518 tertiary care patients and 118 non-COPD subjects) were included. The burden of disease significantly increased from primary care to tertiary care. However, in all three healthcare settings a high percentage of patients with an impaired health status was observed (i.e. CAT ≥10 points, 68.0% vs. 91.0% vs. 94.5%, respectively). Furthermore, many patients treated in secondary care remain highly symptomatic despite treatment, while others with low burden of disease would allow for de-intensification of care.
  
  
  
  This study revealed important shortcomings and challenges for the care of COPD patients in the Netherlands. It emphasizes the need for detailed patient characterization and more individualized treatment, independent of the healthcare setting.
authors: Department of Research & Education, CIRO, Hornerheide 1, 6085 NM, Horn, The Netherlands. Electronic address: dionnesmid@ciro-horn.nl.
authors: Dionne E
authors: DE
authors: Smid
authors: Department of Research & Education, CIRO, Hornerheide 1, 6085 NM, Horn, The Netherlands.
authors: Martijn A
authors: MA
authors: Spruit
authors: Department of Research & Education, CIRO, Hornerheide 1, 6085 NM, Horn, The Netherlands.
authors: Sarah
authors: S
authors: Houben-Wilke
authors: Caphri School of Public Health and Primary Care, Department of Family Medicine, P.O. Box 616, 6200 MD, Maastricht University, Maastricht, The Netherlands.
authors: Jean W M
authors: JWM
authors: Muris
authors: Department of Respiratory Medicine, Maastricht University Medical Centre, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
authors: Gernot G U
authors: GGU
authors: Rohde
authors: Department of Research & Education, CIRO, Hornerheide 1, 6085 NM, Horn, The Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
authors: Emiel F M
authors: EFM
authors: Wouters
authors: Department of Research & Education, CIRO, Hornerheide 1, 6085 NM, Horn, The Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
authors: Frits M E
authors: FME
authors: Franssen
mesh_terms: D000339:Affect / Q000145:classification / Q000502:physiology; D000368:Aged; D017281:Cost of Illness; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D018450:Disease Progression; D005260:Female; D006304:Health Status; D006801:Humans; D007380:Intermediate Care Facilities / Q000592:standards*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D009426:Netherlands / Q000453:epidemiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy*; D011788:Quality of Life; D012129:Respiratory Function Tests / Q000379:methods; D018570:Risk Assessment; D012720:Severity of Illness Index
keywords: COPD; Disease burden; Functional mobility; Health status; Healthcare settings; Mood status