Pulmonary rehabilitation in COPD – available resources and utilization in Swedish primary and secondary care

Figures & data

Figure 1 Flowchart.

Abbreviation: PHCCs, primary health care centers.

Table 1 Patient characteristics

Patient characteristics	Primary care	Secondary care	P-value
	(N=893)	(N=436)
Sex
Female	496 (56%)	249 (57%)	Ref
Male	397 (44%)	187 (43%)	0.589
Age (years)
<61	138 (15%)	63 (14%)	Ref
61–70	411 (46%)	212 (49%)	0.483
>70	344 (39%)	161 (37%)	0.890
Smoking
Never	40 (5%)	17 (4%)	0.181
Ex	516 (59%)	313 (74%)	<0.0001
Occasionally	54 (6%)	21 (5%)	0.243
Current daily	270 (31%)	75 (18%)	Ref
Education
Low	688 (79%)	342 (80%)	Ref
High	182 (21%)	87 (20%)	0.789
Physical activity
1	265 (31%)	172 (41%)	Ref
2	541 (63%)	227 (55%)	0.001
3	49 (5%)	14 (3%)	0.010
4	4 (1%)	2 (1%)	0.851
BMI
Underweight	48 (5%)	34 (8%)	0.078
Normal	217 (25%)	98 (23%)	Ref
Overweight	354 (41%)	168 (40%)	0.747
Obesity	250 (29%)	120 (29%)	0.711
Heart disease
No	710 (81%)	317 (74%)	Ref
Yes	168 (19%)	114 (26%)	0.002
Diabetes
No	749 (85%)	356 (82%)	Ref
Yes	129 (15%)	76 (18%)	0.174
Anxiety/depression
No	669 (76%)	317 (73%)	Ref
Yes	209 (24%)	114 (27%)	0.297
Exacerbations recent year
0	653 (74%)	255 (60%)	Ref
1	120 (14%)	77 (18%)	0.002
≥2	104 (12%)	92 (22%)	<0.0001
Health status
CAT <10	220 (26%)	80 (20%)	Ref
CAT ≥10	628 (74%)	331 (80%)	0.011

Notes: Patient characteristics, distributed over level of care. In variables with two categories, χ² test was used. In variables with >2 categories, univariable logistic regression was used to compare each category with the reference category. Physical activity categories: 1, no physical activity; 2, walking or bicycling at least 4 hours/week; 3, exercise training at least 3 hours/week; or 4, advanced and regular exercise training several times a week.

Abbreviations: BMI, body mass index; CAT, COPD Assessment Test; Ref, reference group.

Table 2 Access to asthma/COPD clinics and multidisciplinary team work

Rehabilitation resources	PHCCs	Hospitals
	(n=54)	(n=14)
Asthma/COPD clinics	47 (87%)	10 (71%)
Multidisciplinary teamwork	21/54 (39%)	10/14 (71%)
Physiotherapist	20/21 (95%)	10/10 (100%)
Occupational therapist	13/21 (62%)	8/10 (57%)
Nutritionist	7/21 (33%)	9/10 (64%)
Counselor or psychologist	10/21 (48%)	9/10 (64%)

Note: Access to asthma/COPD clinics and rehabilitation professionals within a multidisciplinary teamwork, distributed over level of care.

Abbreviation: PHCCs, primary health care centers.

Table 3 Access to separate professions in PHCCs

Rehabilitation professionals in primary care	N (%)
Asthma/COPD nurse with special education	44/54 (82%)
Physiotherapist	44/54 (82%)
Occupational therapist	38/54 (70%)
Nutritionist	33/54 (61%)
Counselor or psychologist	53/54 (98%)

Note: Access to separate rehabilitation professionals in primary care.

Abbreviation: PHCCs, primary health care centers.

Figure 2 Utilization of rehabilitation professionals in the previous year.

Note: Proportions of patients having met pulmonary rehabilitation professionals in the previous year, distributed over level of care.

Table 4 Patient characteristics associated with having seen different rehabilitation professionals in the previous year

Patient characteristics	Asthma/COPD nurse OR (95% CI)	Physiotherapist OR (95% CI)	Occupational therapist OR (95% CI)	Nutritionist OR (95% CI)	Counselor OR (95% CI)
Male sex	1.00 (0.78 to 1.30)	0.81 (0.51 to 1.27)	1.20 (0.64 to 2.26)	1.70 (1.03 to 2.82)	0.60 (0.22 to 1.65)
Age (years)
<61	Ref	Ref	Ref	Ref	Ref
61–70	1.35 (0.91 to 1.98)	1.39 (0.70 to 2.78)	0.83 (0.34 to 2.01)	1.97 (0.84 to 4.62)	0.51 (0.15 to 1.68)
>70	1.28 (0.85 to 1.92)	1.32 (0.64 to 2.73)	0.82 (0.32 to 2.13)	1.71 (0.69 to 4.20)	0.58 (0.16 to 2.03)
Current smoking	0.70 (0.51 to 0.95)	0.31 (0.17 to 0.55)	0.46 (0.20 to 1.06)	0.54 (0.28 to 1.02)	0.09 (0.01 to 0.73)
Physical activity	1.05 (0.83 to 1.32)	0.96 (0.64 to 1.44)	0.62 (0.33 to 1.15)	1.18 (0.74 to 1.86)	0.71 (0.28 to 1.78)
BMI
Underweight	0.55 (0.30 to 1.01)	1.19 (0.55 to 2.59)	1.83 (0.69 to 4.86)	2.98 (1.35 to 6.56)	3.53 (0.81 to 15.3)
Normal	Ref	Ref	Ref	Ref	Ref
Overweight	1.06 (0.77 to 1.47)	0.49 (0.26 to 0.78)	0.75 (0.34 to 1.66)	0.50 (0.26 to 0.96)	1.05 (0.27 to 4.14)
Obesity	0.98 (0.69 to 1.40)	0.43 (0.23 to 0.79)	0.46 (0.19 to 1.15)	0.44 (0.22 to 0.89)	1.04 (0.26 to 4.19)
Diabetes	1.07 (0.75 to 1.53)	1.27 (0.69 to 2.32)	1.35 (0.58 to 3.18)	4.02 (2.24 to 7.22)	1.65 (0.48 to 5.63)
Anxiety/depression	1.03 (0.76 to 1.40)	1.33 (0.81 to 2.17)	1.23 (0.62 to 2.42)	1.58 (0.91 to 2.74)	2.56 (1.03 to 6.41)
Exacerbations
0	Ref	Ref	Ref	Ref	Ref
1	1.33 (0.94 to 1.89)	1.89 (1.04 to 3.43)	3.65 (1.60 to 8.36)	1.29 (0.63 to 2.65)	5.07 (1.15 to 22.4)
≥2	2.04 (1.40 to 2.96)	5.35 (3.16 to 9.05)	5.54 (2.54 to 112.1)	3.65 (2.04 to 6.55)	11.3 (2.91 to 43.6)
Health status (CAT)	1.06 (1.04 to 1.07)	1.06 (1.03 to 1.09)	1.08 (1.04 to 1.13)	1.08 (1.04 to 1.11)	1.07 (1.00 to 1.15)

Note: Results from multivariable logistic regression analyses with separate pulmonary rehabilitation professionals as dependent variables and sex, age, and statistically significant variables from the univariable analyses as independent variables.

Abbreviations: BMI, body mass index; CAT, COPD Assessment Test; CI, confidence interval; OR, odds ratio; Ref, reference group.

Figure 3 Patient factors associated with having received multidisciplinary rehabilitation.

Notes: Proportions of patients with stable and low health status and respective annual number of exacerbations having met different pulmonary rehabilitation professionals in the previous year. P-values from multivariable regression analyses.
Abbreviations: CAT, COPD Assessment Test; Ex, numbers of COPD exacerbations recent year.