Under pressure: Patient characteristics associated with primary care respiratory treatment reviews before respiratory winter pressures in the UK

Abstract

Introduction Chronic obstructive pulmonary disease (COPD) and asthma present substantial clinical and economic burdens and are the leading cause of admissions and 'winter pressures' on the UK National Health Service. Our study will explore epidemiological factors associated with respiratory treatment review in primary care, before respiratory winter pressures. Methods This interim analysis of a retrospective cohort study uses Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) linked datasets. Adult patients alive at index (01/11/2022) with a history of asthma or COPD were included. Index characteristics stratified by primary care treatment review codes in the 12-months prior to index are reported. Results Key demographics are presented in table 1. Of 1,412,720 patients with asthma, 32.5% (459,651) had received a treatment review. Reviewed patients were older (48 vs 39 years), had more comorbidities (Charlson Comorbidity Index CCI] 1.7 vs 1.4, 32% vs 18.9% with cardiovascular comorbidities), had a higher proportion with exacerbations in the year prior (13.8% vs 4.9%) and had a greater number of respiratory medications; a higher proportion received any ICS (89% vs 74%), ICS+LABA (47% vs 14%), and SABA (99.5% vs 91.4%). Of the 186,297 patients with COPD, 52.0% (96,949) received a treatment review. Patients reviewed tended to be older (72 vs 67 years), had a higher burden of comorbidities (CCI 3.0 vs 2.5, 68% vs 58.9% with cardiovascular comorbidities), and a higher proportion of patients receiving more advanced therapies (e.g. triple therapy, 30.2% vs 13.4%). Patients reviewed also had higher burden of moderate exacerbations (30.0% moderate, 2.9% severe vs 16.5% moderate, 1.9% severe). Notably, of the 43,758 patients with moderate and 4,507 patients with prior severe exacerbations, only 66% and 63% respectively were reviewed in the prior year. Conclusions Treatment reviews for asthma and COPD predominantly targeted patients at higher disease risk, yet notably, some high-risk individuals'such as those with prior hospitalisation'did not receive a review. Outcomes during winter and the effects of treatment review and disease control will be addressed in forthcoming analyses. Preliminary findings emphasise the need to investigate missed opportunities for review and to identify further strategies to improve patient care before winter.