Emergency Admissions for COPD in an Urban Population: The Role of Population and Primary Care Factors

Figures & data

Table 1.  Practice admission rates, practice characteristics, and practice performance data for 1566 (92%) eligible London practices, population 8,456,186. 2006–2009

	2006	2007	2008	2009
	Median (IQR)	Median (IQR)	Median (IQR)	Median (IQR)
Practice COPD admissions per 10,000 patients	13.68 (7.83–22.70)	13.50 (7.87–20.83)	14.83 (8.83–23.25)	13.40 (7.76–22.02)
Practice geographical deprivation score (IMD)^a	24.97 (14.16–36.35)	25.81 (16.14–38.00)	25.98 (16.15–38.05)	25.94 (16.04–38.20)
Diagnosed COPD prevalence (%)^b	0.81 (0.54–1.14)	0.84 (0.57–1.20)	0.89 (0.61–1.25)	0.92 (0.63–1.26)
White patients–%^c	73 (57–86)	73 (56–86)	73 (56–86)	72 (56–86)
Patients >45 years–%	32 (26–38)	32 (26–38)	32 (27–38)	32 (27–38)
Patients >85 years–%	1.2 (0.8–1.9)	1.3 (0.8–1.9)	1.2 (0.8–1.9)	1.23 (0.8–1.9)
Practice list size	4636 (3,003–7,174)	4751 (3,055–7,290)	4796 (3,073–7,411)	4928 (3,194–7,620)
Single-handed practice–%	28	26	23	20
Training practice–%^d	20	20	20	20
List size per FTE GP^e	1893 (1,479–2,421)	1964 (1,613.3–2,430)	1928 (1,603–2,425)	1834 (1,413–2,312)
Practice nurses FTE/1000 patients^f	0.23 (0.2–0.27)	0.23 (0.19–0.25)	0.22 (0.17–0.25)	0.22 (0.19–0.25)
QOF total points/ points available^g	0.97 (0.93–0.99)	0.98 (0.95 – 0.99)	0.95 (0.93–0.97)	0.94 (0.91–0.96)
QOF smoking cessation offered to patients with chronic diseases^h	0.94 (0.91–0.96)	0.94 (0.91–0.97)	0.93 (0.91–0.96)	0.93 (0.90–0.96)
COPD diagnosis confirmed by spirometry^i	0.89 (0.80–0.94)	0.89 (0.83–0.95)	1.0 (0.86–1.0)	0.80 (0.67–0.92)
The ability to book a consultation with a GP within 2 working days^j	-	-	0.82 (0.73–0.88)	0.79 (0.71–0.86)
The ability to book an appointment with a GP more than 2 days ahead^k	-	-	0.79 (0.68–0.88)	0.75 (0.65–0.84)

aIMD (Index of Multiple Deprivation) score: overall measure of multiple deprivation experienced by people living in an area.

bNational COPD prevalence = 1.65%.

c% of white patients (all subgroups) national figure from 2011 census = 86.0% [ONS. http://www.ons.gov.uk/ons/rel/census/2011-census/key-statistics-for-local-authorities-in-england-and-wales/rpt-ethnicity.html].

dTraining practices: practices where at least one general practitioner has a formal responsibility for post-graduate training of general practitioners.

eFTE = full-time equivalent. GP = general practitioner (excluding retainers and registrars)

fPractice nurses rate = PCT level data.

gQOF (Quality and Outcomes Framework): an incentivised performance system for general practitioners in the United Kingdom.

hQOF indicator ‘Smoking 2’ for 2006/7, 2007/8 and ‘Smoking 4’ for 2008/9, 2009/10.

iQOF indicator ‘COPD 9’ for 2006/7, 2007/8 and ‘COPD 12’ for 2008/9, 2009/10.

j QOF indicator PE7 derived from the National Patient Survey (ref).

kQOF indicator PE8 derived from the National Patient Survey (ref).

Figure 1.  COPD admissions per 10,000 patients on the list (mean and 95% confidence intervals) in London, UK from 2006 to 2009.

Figure 2.  COPD admissions per 10,000 patients on the list (mean and 95% confidence intervals) for each calendar month in the four years from 2006 to 2009.

Table 2.  Association of practice performance and population characteristics with COPD admission rates: univariable and multivariable analysis using negative binomial regression

	Rate Ratio (exponent of B)	p-value	95% confidence interval	Rate Ratio (exponent of B)	p-value	95% confidence interval
				Univariable analysis^a	Multivariable analysis^a
IMD^b score	1.01	<0.001	1.01–1.01	1.01	<0.001	1.01–1.02
Diagnosed COPD prevalence (%)	2.06	<0.001	1.84–2.3	1.85	<0.001	1.63–2.1
% of white patients	1.51	0.02	1.16–1.96	1.33	0.097	0.95–1.87
% of patients aged >45 years	1.01	0.01	1.0–1.02	1.0	0.462	0.99–1.06
% of patients aged >85 years	1.12	0.001	1.05–1.19	1.03	0.533	0.94–1.14
List size per FTE^c GP^d (/100)	0.99	0.083	0.99–1.0	1.0	0.970	0.99–1.01
Practice nurses FTE/1000	2.24	0.090	0.88–5.69	0.68	0.441	0.26–1.8
COPD patients received influenza immunisation in preceding 12 months (COPD8^e)	0.4	0.001	0.23–0.69	0.74	0.279	0.42–1.28

aUsing QOF–(Quality and Outcomes Framework: an incentivised performance system for general practitioners in the UK) data from 2007/8.

bIMD (Index of Multiple Deprivation) score: overall measure of multiple deprivation experienced by people living in an area.

cFTE = full-time equivalent.

dGP = general practitioner (excluding retainers and registrars).

eQOF indicator COPD8 for 2007–2008.

Ashworth M. The quality and outcomes framework in the United kingdom: indicators in transition. J Ambul Care Mgmt 2012; 35(3):200–205.

 Google Scholar

Department of Health. An Outcomes Strategy for Chronic Obstructive Pulmonary Disease (COPD) and Asthma. London: 2011 7/1/2011.

 Google Scholar

Bryden C, Bird W, Titley HA et al. Stratification of COPD patients by previous admission for targeting of preventative care. Respir Med 2009; 103(4):558–565.

 Google Scholar

Damiani M, Dixon J. COPD Medical Admissions in the UK. Newmarket, UK: Hayward Medical Publications, 2004.

 Google Scholar

Britton M. The burden of COPD in the U.K.: Results from the Confronting COPD survey. RespirMed. 2003; 97 Suppl C:S71–S9.

 Google Scholar