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Respiratory medicine
Original research
Impact of community-based chronic obstructive pulmonary disease service, a multidisciplinary intervention in an area of high deprivation: a longitudinal matched controlled study
  1. Pooja Saini1,
  2. Tanith Rose2,
  3. Jennifer Downing3,
  4. Bashir Matata4,
  5. Samantha Pilsworth5,
  6. Allan Pemberton5,
  7. Terence Comerford5,
  8. Keith Wilson5,
  9. Matthew Shaw6,
  10. Lesley M Harper7,
  11. Konstantinos Daras2,
  12. Benjamin Barr2
  1. 1Psychology, Liverpool John Moores University, Liverpool, UK
  2. 2Public Health and Policy, University of Liverpool, Liverpool, UK
  3. 3Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
  4. 4Clinical Trials Unit/Clinical Quality, Liverpool Heart & Chest Hospital NHS Foundation Trust, Liverpool, UK
  5. 5Clinical Trials Unit/Clinical Quality, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
  6. 6Adult CF centre, The Liverpool Heart and Chest Hospital, Liverpool, UK
  7. 7Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
  1. Correspondence to Dr Pooja Saini; P.Saini{at}ljmu.ac.uk

Abstract

Objective To examine the effects of a consultant-led, community-based chronic obstructive pulmonary disease (COPD) service, based in a highly deprived area on emergency hospital admissions.

Design A longitudinal matched controlled study using difference-in-differences analysis to compare the change in outcomes in the intervention population to a matched comparison population, 5 years before and after implementation.

Setting A deprived district in the North West of England between 2005 and 2016.

Intervention A community-based, consultant-led COPD service providing diagnostics, treatment and rehabilitation from 2011 to 2016.

Main outcome measures Emergency hospital admissions, length of stay per emergency admission and emergency readmissions for COPD.

Results The intervention was associated with 24 fewer emergency COPD admissions per 100 000 population per year (95% CI −10.6 to 58.8, p=0.17) in the postintervention period, relative to the control group. There were significantly fewer emergency admissions in populations with medium levels of deprivation (64 per 100 000 per year; 95% CI 1.8 to 126.9) and among men (60 per 100 000 per year; 95% CI 12.3 to 107.3).

Conclusion We found limited evidence that the service reduced emergency hospital admissions, after an initial decline the effect was not sustained. The service, however, may have been more effective in some subgroups.

  • COPD
  • pulmonary rehabilitation
  • respiratory medicine (see thoracic medicine)
  • readmission
  • A&E attendance
  • community care multidisciplinary
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2019-032931

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    Footnotes

    • PS and TR are joint first authors.

    • Twitter @poojaliverpool

    • Contributors PS and BB conceived the study design. All the team developed the study and contributed to finalising the research question (PS, TR, JD, BM, SP, AP, LMH, TR, KW, KD and BB). Analysis (TR and BB) indicators (KD) local data (MS). BM and SP supported this work providing information of the nature of the intervention, contextual information and fact-checking the final draft. PS, TR and BB drafted the manuscript and all other authors (JD, BM, SP, AP, LMH, TR, KW and KD) critically assessed and contributed to the paper and agreed the final manuscript. We would like to thank the public advisors (AP, TC and KW) who contributed throughout the paper and we look forward to continuing our work with them in the future. BB is guarantor for the study. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

    • Funding The study was part-funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care North West Coast (NIHR CLAHRC NWC) (Grant/Award Number: CLAHRC-NWC-167) and Liverpool Heart and Chest Hospital NHS Trust.

    • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The views expressed in this manuscript are those of the author and do not represent Liverpool Heart and Chest NHS Foundation Trust. There are no other relationships or activities that could appear to have influenced the submitted work.

    • Competing interests This study was supported by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care North West Coast (NIHR CLAHRC NWC). All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: BM and SP are employed by Liverpool Heart and Chest NHS Foundation Trust the provider of KCOPD and were involved in providing information about the nature of the intervention and providing contextual information on request when interpreting the results. AP is an elected governor and KW is employed as patient ambassador at Liverpool Heart and Chest NHS Foundation Trust, both were involved as a public advisors. They had no role in the analysis or presentation of the results.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data may be obtained from a third party and are not publicly available. All data relevant to the study are included in the article or uploaded as online supplementary information. The manuscript’s guarantor (BB) affirms that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.