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  • 1. Sundh, Josefin
    et al.
    Österlund Efraimsson, Eva
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Janson, Christer
    Montgomery, Scott
    Stallberg, Bjorn
    Lisspers, Karin
    Management of COPD exacerbations in primary care: a clinical cohort study2013In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 22, no 4, p. 393-399Article in journal (Refereed)
    Abstract [en]

    Background: Chronic obstructive pulmonary disease (COPD) exacerbations are associated with lung function decline, lower quality of life, and increased mortality, and can be prevented by pharmacological treatment and rehabilitation.

    Aims: To examine management including examination, treatment, and planned follow-up of COPD exacerbation visits in primary care patients and to explore how measures and management at exacerbation visits are related to subsequent exacerbation risk.

    Methods: A clinical population of 775 COPD patients was randomly selected from 56 Swedish primary healthcare centres. Data on patient characteristics and management of COPD exacerbations were obtained from medical record review and a patient questionnaire. In the study population of 458 patients with at least one exacerbation, Cox regression analyses estimated the risk of a subsequent exacerbation with adjustment for age and sex.

    Results: During a follow-up period of 22 months, 238 patients (52%) had a second exacerbation. A considerable proportion of the patients were not examined and treated as recommended by guidelines. Patients with a scheduled extra visit to an asthma/COPD nurse following an exacerbation had a decreased risk of further exacerbations compared with patients with no extra follow-up other than regularly scheduled visits (adjusted hazard ratio 0.60 (95% confidence interval 0.37 to 0.99), p=0.045).

    Conclusions: Guidelines for examination and emergency treatment at COPD exacerbation visits are not well implemented. Scheduling an extra visit to an asthma/COPD nurse following a COPD exacerbation may be associated with a decreased risk of further exacerbations in primary care patients. (C) 2013 Primary Care Respiratory Society UK. All rights reserved.

  • 2.
    Zakrisson, Ann-Britt
    et al.
    Örebro universitet, Hälsoakademin.
    Engfeldt, Peter
    Örebro universitet, Hälsoakademin.
    Hägglund, Doris
    Örebro universitet, Hälsoakademin.
    Odencrants, Sigrid
    Örebro universitet, Hälsoakademin.
    Hasselgren, Mikael
    Centre for Assessment of Medical Technology in Örebro, Sweden ; Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology, Uppsala University, Sweden ; Primary Care Research Unit, County Council in Värmland, Karlstad, Sweden.
    Arne, Mats
    Centre for Assessment of Medical Technology in Örebro, Sweden ; Primary Care Research Unit, County Council in Värmland, Karlstad, Sweden.
    Theander, Kersti
    epartment of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology, Uppsala University, Sweden ; Primary Care Research Unit, County Council in Värmland, Karlstad, Sweden ; Department of Nursing, Karlstad University, Sweden.
    Nurse-led multidisciplinary programme for patients with COPD in primary health care: a controlled trial2011In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 20, no 4, p. 427-433Article in journal (Refereed)
    Abstract [en]

    AIM:To investigate the effects of a nurse-led multidisciplinary programme (NMP) of pulmonary rehabilitation in primary health care with regard to functional capacity, quality of life (QoL), and exacerbations among patients with chronic obstructive pulmonary disease (COPD).

    METHOD:A 1-year longitudinal study with a quasi-experimental design was undertaken in patients with COPD, 49 in the intervention group and 54 in the control group. Functional capacity was assessed using the 6-minute walking test, and quality of life (QoL) was assessed using the Clinical COPD Questionnaire. Exacerbations were calculated by examination of patient records.

    RESULTS:No significant differences were found between the groups in functional capacity and QoL after 1 year. The exacerbations decreased in the intervention group (n = -0.2) and increased in the control group (n = 0.3) during the year after NMP. The mean difference of change in exacerbation frequency between the groups was statistically significant after one year (p=0.009).

    CONCLUSIONS:The NMP in primary care produced a significant reduction in exacerbation frequency, but functional capacity and QoL were unchanged. More and larger studies are needed to evaluate potential benefits in functional capacity and QoL.

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