Describing characteristics of a primary care COPD population receiving Integrated Disease Management and the durability of quality of life outcomes over time

Abstract

<b>Introduction:</b> Integrated Disease Management (IDM), a team-based approach to COPD, is being adopted to promote best-practice guideline concordance. <b>Objective:</b> To describe clinical and demographic characteristics of a primary care COPD IDM cohort, investigate baseline differences by GOLD stage and document the change in quality of life (QoL) over 36 months of follow-up. <b>Methods:</b> Individuals with an objectively confirmed COPD diagnosis, receiving IDM from 2012−2019 were included. Summary statistics were compared using point estimates and confidence intervals. COPD assessment test scores (CAT) were used to measure QoL over the follow-up period. <b>Results:</b> 5766 COPD patients were included, with a median 10 month follow-up. Mean age was 68.1±10.12yrs, 53% male, 38% obese, 46% with &gt;1 comorbidity, and 26% with a high poverty index. GOLD 2017 classification distribution was, A 13%, B 44%, C 3% and D 25%. High risk, stage C/D, showed differences compared to A/B; there were more females (52% vs 45%), &gt;3comorbidities (43% vs 33%), &gt;2unscheduled acute health service use related to COPD (88% vs 28%). The largest sustained 3 year improvements in QoL (reduced mean CAT score) were GOLD D 20.7(95%CI 19.6−21.8) to 17.1(CI 15.9−18.3), poor baseline QoL 23.6(CI 23.5−23.8) to 18.8(CI 18.5−19.2), and very poor baseline QoL 32.7(CI 32.4-33.1) to 24.5(CI 23.6-25.3). <b>Conclusion:</b> We characterized a large Canadian primary care IDM COPD population, specifically enriched for high-risk individuals and identified a female predominance, multiple comorbidities and urgent health services utilization with sustained QoL improvement over 3yrs.