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Low uptake of palliative care for COPD patients within primary care in the UK

Bloom, CI; Slaich, B; Morales, DR; Smeeth, L; Stone, P; Quint, JK; (2018) Low uptake of palliative care for COPD patients within primary care in the UK. European Respiratory Journal , 51 (2) , Article 1701879. 10.1183/13993003.01879-2017. Green open access

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Abstract

Mortality and symptom burden from chronic obstructive pulmonary disease (COPD) and lung cancer are similar but there is thought to be an inequality in palliative care support (PCS) between diseases. This nationally representative study assessed PCS for COPD patients within primary care in the UK.This was a cohort study using electronic healthcare records (2004-2015). Factors associated with receiving PCS were assessed using logistic regression for the whole cohort and deceased patients.There were 92 365 eligible COPD patients, of which 26 135 died. Only 7.8% of the whole cohort and 21.4% of deceased patients received PCS. Lung cancer had a strong association with PCS compared with other patient characteristics, including Global Initiative for Chronic Obstructive Lung Disease stage and Medical Research Council Dyspnoea score (whole cohort, lung cancer: OR 14.1, 95% CI 13.1-15; deceased patients, lung cancer: OR 6.5, 95% CI 6-7). Only 16.7% of deceased COPD patients without lung cancer received PCS compared with 56.5% of deceased patients with lung cancer. In patients that received PCS, lung cancer co-diagnosis significantly increased the chances of receiving PCS before the last month of life (1-6versus≤1 month pre-death: risk ratio 1.4, 95% CI 1.3-1.7).Provision of PCS for COPD patients in the UK is inadequate. Lung cancer, not COPD, was the dominant driver for COPD patients to receive PCS.

Type: Article
Title: Low uptake of palliative care for COPD patients within primary care in the UK
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1183/13993003.01879-2017
Publisher version: http://doi.org/10.1183/13993003.01879-2017
Language: English
Additional information: Copyright © ERS 2018. This ERJ Open article is open access and distributed under the terms of the Creative Commons Attribution Licence 4.0.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry
URI: https://discovery.ucl.ac.uk/id/eprint/10046953
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