Impaired health status in primary care COPD patients is underestimated

Abstract

Background: The vast majority of patients with COPD are treated in primary care. It is assumed that these patients experience only mild health status impairment compared to patients in specialized care. However, studies providing a detailed assessment of health status in primary care COPD patients are lacking. Aims: To assess health status in primary care COPD patients and to compare this with secondary/tertiary care. Methods: We assessed health status using the Nijmegen Clinical Screening Instrument (NCSI). The NCSI provides a detailed assessment of health status by measuring eight sub-domains, covering symptoms, functional impairment, and quality of life. Normative data indicate sub-domain scores as normal functioning, mild impairment or severe impairment. We compared the primary care COPD patients with patients from a specialized respiratory care outpatient clinic. Results: We collected data from 134 Dutch primary care COPD patients (57% male, mean post-BD FEV1 66% predicted) and compared these with 303 specialized care patients (63% male, mean post-BD FEV1 55% predicted). Percentages of primary care patients with severe impairment varied from 21% (sub-domain “satisfaction relations”) to 65% (sub-domain “general quality of life”). This was comparable to specialized care. Fifty percent of primary care patients experienced severe impairment in at least three of the eight NCSI sub-domains compared to 63% in specialized care patients. Conclusion: One in every two COPD patients in primary care seems to experience severe health status impairment, which is unexpected and only slightly lower than in specialized care. Assessing health status should be an important part of routine COPD care in general practice.