Feasibility and effectiveness of an Asthma/COPD service for primary care: a cross-sectional baseline description and longitudinal results

Metting, Esther; Ra, Riemersma; Kocks, Janwillem; Piersma-Wichers, Margriet; Sanderman, Robbert; Molen, Thys van der

doi:10.1038/npjpcrm.2014.101

Cited by 28 publications

(53 citation statements)

References 27 publications

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“…Indeed, in a recent study performed in 12 primary care practices in the UK showed considerable more patients with an ACQ score<2.0 than in our observation (79% versus 43%) [25]. Another study, carried out in primary care in the Netherlands by Metting et al showed fewer patients with uncontrolled asthma (39% versus 65%) compared to the number in our study [26]. Specific features of the asthma such as presence of exercise induced bronchoconstriction, time of onset of asthma and the medication regime patients were actually on at the time of referral to secondary care were not systematically collected in the present study.…”

Section: Strengths and Limitations Of This Studycontrasting

confidence: 70%

Decreased physical activity in adults with bronchial asthma

Hul

Frouws²,

Akker

et al. 2016

Respiratory Medicine

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Contradictory findings have been reported in the literature on the impact that bronchial asthma may have on habitual physical activity. The present study was designed to compare physical activity, objectively measured with an activity monitor, between adults with bronchial asthma and apparently healthy controls. Valid registrations of physical activity were obtained in 226 patients with asthma and 201 healthy controls. A multiple general linear model was used to test between group differences and to correct for confounding of the results due to between group differences in BMI and employment status. In the patients, statistically significantly lower values were found for average steps/day (-1202; CI -1893 to -511; P = 0.001), physical activity level based on an estimate of a person's total energy expenditure (-0.035; CI -0.067 to -0.003); P = 0.034) and daily time (minutes) spent at vigorous intensive physical activity (-11; CI -17 to -1; P < 0.001). In addition, weak albeit significant correlations were found between measures of physical activity and asthma control. We conclude that bronchial asthma in adults is associated with a significant reduction in physical activity as compared to apparently healthy controls and is accompanied by a lower perceived health status. This is in support of the postulation of PA as potential pathway to better the outcome of care for these patients.

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Section: Strengths and Limitations Of This Studycontrasting

confidence: 70%

Decreased physical activity in adults with bronchial asthma

Hul

Frouws²,

Akker

et al. 2016

Respiratory Medicine

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“…This might have been caused by the diagnostic variation among pulmonologists, which was previously described by M etting et al [7]. Despite this diagnostic variation between the pulmonologists, additional data from 1856 patients showed that most diagnoses were confirmed at follow-up (confirmed in 92% of the asthma patients, in 86% of the COPD patients and in 73% of the ACOS patients).…”

Section: Discussionmentioning

confidence: 88%

Development of a diagnostic decision tree for obstructive pulmonary diseases based on real-life data

et al. 2016

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The aim of this study was to develop and explore the diagnostic accuracy of a decision tree derived from a large real-life primary care population.Data from 9297 primary care patients (45% male, mean age 53±17 years) with suspicion of an obstructive pulmonary disease was derived from an asthma/chronic obstructive pulmonary disease (COPD) service where patients were assessed using spirometry, the Asthma Control Questionnaire, the Clinical COPD Questionnaire, history data and medication use. All patients were diagnosed through the Internet by a pulmonologist. The Chi-squared Automatic Interaction Detection method was used to build the decision tree. The tree was externally validated in another real-life primary care population (n=3215).Our tree correctly diagnosed 79% of the asthma patients, 85% of the COPD patients and 32% of the asthma–COPD overlap syndrome (ACOS) patients. External validation showed a comparable pattern (correct: asthma 78%, COPD 83%, ACOS 24%).Our decision tree is considered to be promising because it was based on real-life primary care patients with a specialist's diagnosis. In most patients the diagnosis could be correctly predicted. Predicting ACOS, however, remained a challenge. The total decision tree can be implemented in computer-assisted diagnostic systems for individual patients. A simplified version of this tree can be used in daily clinical practice as a desk tool.

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“…Pulmonologists assess these patient data through an online secured internet portal and send a diagnosis and management recommendation to the GP. Currently, 11,000 patients have been assessed by the AC-service, and it is considered to be feasible and effective 14. Comparable outcomes may be expected for the AMSS when it is implemented in a broader fashion.…”

Section: Discussionmentioning

confidence: 99%

Development of an allergy management support system in primary care

Blok¹,

Molen²,

Christoffers³

et al. 2017

JAA

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BackgroundManagement of allergic patients in the population is becoming more difficult because of increases in both complexity and prevalence. Although general practitioners (GPs) are expected to play an important role in the care of allergic patients, they often feel ill-equipped for this task. Therefore, the aim of this study was to develop an allergy management support system (AMSS) for primary care.MethodsThrough literature review, interviewing and testing in secondary and primary care patients, an allergy history questionnaire was constructed by allergists, dermatologists, GPs and researchers based on primary care and specialists’ allergy guidelines and their clinical knowledge. Patterns of AMSS questionnaire responses and specific immunoglobulin E (sIgE)-test outcomes were used to identify diagnostic categories and develop corresponding management recommendations. Validity of the AMSS was investigated by comparing specialist (gold standard) and AMSS diagnostic categories.ResultsThe two-page patient-completed AMSS questionnaire consists of 12 (mainly) multiple choice questions on symptoms, triggers, severity and medication. Based on the AMSS questionnaires and sIgE-test outcome of 118 patients, approximately 150 diagnostic categories of allergic rhinitis, asthma, atopic dermatitis, anaphylaxis, food allergy, hymenoptera allergy and other allergies were identified, and the corresponding management recommendations were formulated. The agreement between the allergy specialists’ assessments and the AMSS was 69.2% (CI 67.2–71.2).ConclusionUsing a systematic approach, it was possible to develop an AMSS that allows for the formulation of diagnostic and management recommendations for GPs managing allergic patients. The AMSS thus holds promise for the improvement of the quality of primary care for this increasing group of patients.

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Feasibility and effectiveness of an Asthma/COPD service for primary care: a cross-sectional baseline description and longitudinal results

Cited by 28 publications

References 27 publications

Decreased physical activity in adults with bronchial asthma

Decreased physical activity in adults with bronchial asthma

Development of a diagnostic decision tree for obstructive pulmonary diseases based on real-life data

Development of an allergy management support system in primary care

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