Influence of socioeconomic and demographic status on spirometry testing in patients initiating medication targeting obstructive lung disease: a population-based cohort study

Koefoed, Mette Marie; Søndergaard, Jens; Christensen, René dePont; Jarbøl, Dorte Ejg

doi:10.1186/1471-2458-13-580

Cited by 7 publications

(10 citation statements)

References 34 publications

(36 reference statements)

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“…This contrasts with a UK study showing lower use of spirometry among socioeconomically deprived patients, 18 and in part with a Danish study that found lower use of spirometry among patients with the highest level of education. 19 …”

Section: Discussionmentioning

confidence: 99%

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GP utilisation by education level among adults with COPD or asthma: a cross-sectional register-based study

Hetlevik

Melbye

Gjesdal

2016

npj Prim Care Resp Med

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There is a marked socioeconomic gradient in the prevalence of chronic obstructive pulmonary disease (COPD) and asthma, but a large proportion of patients remain undiagnosed. It is a challenge for general practitioners (GPs) to both identify patients and contribute to equity and high quality in services delivered. The aim of this study was to identify patients with COPD and asthma diagnoses recorded by GPs and explore their utilisation of GP services by education level. This was a cross-sectional, national, register-based study from Norwegian general practice in the period 2009–2011. Based on claims from GPs, the number of patients aged ⩾40 years with a diagnosis of COPD or asthma and their GP services utilisation were estimated and linked to the national education database. Multivariate Poisson and logistic regression models were used to explore the variations in GP utilisation. In the population aged ⩾40 years, 2.8% had COPD and 3.8% had asthma according to GPs’ diagnoses. COPD was four times more prevalent in patients with basic education than higher education; this increase was ⩽80% for asthma. Consultation rates were 12% higher (P<0.001) for COPD and 25% higher (P<0.001) for asthma in patients with low versus high education in the age group of 40–59 years after adjusting for comorbidity, and patient and GP characteristics. Approximately 25% of COPD patients and 20% of asthma patients had ⩾1 spirometry test in general practice in 2011, with no significant education differences in adjusted models. The higher consultation rate in lower-education groups indicates that GPs contribute to fair distribution of healthcare.

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Section: Discussionmentioning

confidence: 99%

“… 13 Lower socioeconomic status (SES) has also been found to be associated with reduced health-care access, infrequent monitoring with spirometry and worsening of the prognosis of COPD. 11 , 18–20 …”

Section: Introductionmentioning

confidence: 99%

GP utilisation by education level among adults with COPD or asthma: a cross-sectional register-based study

Hetlevik

Melbye

Gjesdal

2016

npj Prim Care Resp Med

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“…Seeking medical help is a complex process, shaped by demographic, structural and individual factors such as age, sex, access to healthcare, socioeconomic inequalities, cultural norms, gender roles and education. 7–10 Most quantitative research documenting patterns in primary healthcare use is based on cross-sectional analysis of aggregate-level data. These findings have consistently shown that women use primary healthcare services more often than same-aged men—even when excluding consultations for childbearing and birth control.…”

Section: Introductionmentioning

confidence: 99%

Do men avoid seeking medical advice? A register-based analysis of gender-specific changes in primary healthcare use after first hospitalisation at ages 60+ in Denmark

Höhn

Gampe

Lindahl-Jacobsen

et al. 2020

J Epidemiol Community Health

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BackgroundIt remains unclear whether women’s greater primary healthcare use reflects a lower treatment-seeking threshold or a health disadvantage. We address this question by studying primary healthcare use surrounding a major health shock.MethodsThis cohort study utilises routinely-collected healthcare data covering the Danish population aged 60+ years between 1996 and 2011. Using a hurdle model, we investigate levels of non-use and levels of primary healthcare use before and after first inpatient hospitalisation for stroke, myocardial infarction (MI), chronic obstructive pulmonary disease (COPD) and gastrointestinal cancers (GIC).ResultsBefore hospitalisation, irrespective of cause, men were more likely than women to be non-users of primary healthcare (OR (95% CI): stroke 1.802 (1.731 to 1.872); MI 1.841 (1.760 to 1.922); COPD 2.160 (2.028 to 2.292); GIC 1.609 (1.525 to 1.693)). Men who were users had fewer primary healthcare contacts than women (proportional change (eβ) (95% CI): stroke 0.821 (0.806 to 0.836); MI 0.796 (0.778 to 0.814); COPD 0.855 (0.832 to 0.878); GIC 0.859 (0.838 to 0.881)). Following hospitalisation, changes in the probability of being a non-user (OR (95% CI): stroke 0.965 (0.879 to 1.052); MI 0.894 (0.789 to 0.999); COPD 0.755 (0.609 to 0.900); GIC 0.895 (0.801 to 0.988)) and levels of primary healthcare use (eβ (95% CI): stroke 1.113 (1.102 to 1.124); MI 1.112 (1.099 to 1.124); COPD 1.078 (1.063 to 1.093); GIC 1.097 (1.079 to 1.114)) were more pronounced among men. Gender differences widened after accounting for survival following hospitalisation.ConclusionWomen’s consistently higher levels of primary healthcare use are likely to be explained by a combination of a lower treatment-seeking threshold and a health disadvantage resulting from better survival in bad health.

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“…Previous research has demonstrated associations between specific practice and patient characteristics, and spirometry testing, 21 , 22 , 29 and these factors were adjusted for in the analyses. Practice characteristics comprised: GPs’ age and sex, status as training practice (yes/no), and task delegation to practice staff.…”

Section: Methodsmentioning

confidence: 99%

“… 21 Many patients who redeem first-time prescriptions for medication to treat obstructive lung diseases do not undergo spirometry testing 22 and, in recent years, a general underutilisation of spirometry in the diagnosis of both asthma and COPD has been a consistent finding across countries. 23 – 28 Variation has, to some degree, been explained by patient factors 29 and organisational characteristics of the practices. 21 However, considerable variation remains unexplained.…”

Section: Introductionmentioning

confidence: 99%

Are formalised implementation activities associated with aspects of quality of care in general practice? A cross-sectional study

Lykkegaard

Pedersen

et al. 2017

BJGP Open

Self Cite

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BackgroundThere is a substantial variation in how different general practices manage knowledge implementation, including the degree to which activities are collectively and formally organised. Yet, it is unclear how these differences in implementation activities affect quality of care.AimTo investigate if there are associations between specific formalised knowledge implementation activities and quality of care in general practices, exemplified by the use of spirometry testing.Design & settingA nationwide cross-sectional study combining survey and register data in Denmark.MethodAn electronic questionnaire was distributed to GPs, and data on spirometry testing among first-time users of medication against obstructive lung diseases were obtained from national registers. Associations were investigated using multilevel mixed-effect logit models.ResultsGPs from 1114 practices (58%) responded, and 33 788 patients were linked to a responding practice. In partnership practices, the frequency of interdisciplinary and GP meetings affected the quality of care. Interdisciplinary and GP meetings held on a weekly basis were significantly associated with a higher level of quality of care and this was measured by the odds ratio (OR) of patients having spirometry. The development of practice protocols and standard recordings in the electronic medical record (EMR) for a range of disease areas compared with few or no areas at all also impacted the quality of care level provided. The effect of formalised implementation activities was not as evident in single-handed practices as in partnerships.ConclusionThis study provides valuable knowledge for GPs who aim to organise their practice in a way that supports implementation and quality improvement most effectively. Also, results may be useful for managers of implementation strategies and quality improvement initiatives when planning future activities.

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Influence of socioeconomic and demographic status on spirometry testing in patients initiating medication targeting obstructive lung disease: a population-based cohort study

Cited by 7 publications

References 34 publications

GP utilisation by education level among adults with COPD or asthma: a cross-sectional register-based study

GP utilisation by education level among adults with COPD or asthma: a cross-sectional register-based study

Do men avoid seeking medical advice? A register-based analysis of gender-specific changes in primary healthcare use after first hospitalisation at ages 60+ in Denmark

Are formalised implementation activities associated with aspects of quality of care in general practice? A cross-sectional study

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