Supplementary Methods - Dove Medical Press



Supplementary MethodsVariablesThe outcome of the analysis – Referral to PR – was defined as any COPD patient with a Read code in their patient record indicating referral to PR in the 3 years prior to the audit date (01/04/2014 to 31/03/2017). Read codes used to define pulmonary rehabilitation referral and all other events in the patient record can be found on the audit resources webpage ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Y7xzUoUF","properties":{"formattedCitation":"(1)","plainCitation":"(1)","noteIndex":0},"citationItems":[{"id":197,"uris":[""],"uri":[""],"itemData":{"id":197,"type":"webpage","abstract":"Documents developed to help practices participating in the national COPD primary care audit (Wales) 2015–17 navigate the process.","container-title":"RCP London","title":"National COPD primary care audit (Wales) 2015–17: resources","title-short":"National COPD primary care audit (Wales) 2015–17","URL":"","author":[{"literal":"Royal College of Physicians"}],"accessed":{"date-parts":[["2018",6,5]]},"issued":{"date-parts":[["2017",3,29]]}}}],"schema":""} (1). 23 exposures (Table 1) were used as potential predictors of referral to PR. Patients aged under 35 years, and without any events recorded in their patient file in the past 4 years were excluded. Socioeconomic status (SES) was defined using the 2014 Welsh Index of Multiple Deprivation (WIMD). WIMD is a measure of deprivation that ranks the relative deprivation between small areas (or neighbourhoods) of Wales. Values for WIMD are derived by assessing the income, employment, health, education, access to services, community safety, physical environment, and housing in a particular small area ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"exjWLOoY","properties":{"formattedCitation":"(2)","plainCitation":"(2)","noteIndex":0},"citationItems":[{"id":88,"uris":[""],"uri":[""],"itemData":{"id":88,"type":"webpage","abstract":"The latest update of the WIMD ranks was in 2014. The index ranks small areas in Wales according to their relative levels of multiple deprivation. A range of indicators underlie the index ranks.","container-title":"GOV.WALES","language":"en","title":"Welsh Index of Multiple Deprivation (full Index update with ranks): 2014","title-short":"Welsh Index of Multiple Deprivation (full Index update with ranks)","URL":"","author":[{"literal":"Welsh Government"}],"accessed":{"date-parts":[["2019",8,14]]},"issued":{"date-parts":[["2015",8,12]]}}}],"schema":""} (2). WIMD data were provided to us by NWIS split in to 5 categories: 10% most deprived, 10-20% most deprived, 20-30% most deprived, 30-50% most deprived, 50% least deprived. Category of WIMD was derived using the patient’s home post code.13 comorbidities were used and defined as any code ever for the disease (see code lists ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"YwVz33Ig","properties":{"formattedCitation":"(1)","plainCitation":"(1)","noteIndex":0},"citationItems":[{"id":197,"uris":[""],"uri":[""],"itemData":{"id":197,"type":"webpage","abstract":"Documents developed to help practices participating in the national COPD primary care audit (Wales) 2015–17 navigate the process.","container-title":"RCP London","title":"National COPD primary care audit (Wales) 2015–17: resources","title-short":"National COPD primary care audit (Wales) 2015–17","URL":"","author":[{"literal":"Royal College of Physicians"}],"accessed":{"date-parts":[["2018",6,5]]},"issued":{"date-parts":[["2017",3,29]]}}}],"schema":""} (1)) in the patient’s record without a subsequent disease resolved code. The exception to this was painful condition, which was defined as a record of ≥4 analgesic or anti-epileptic (in the absence of an epilepsy diagnosis) prescriptions in the year preceding the audit date.MRC grade recorded in the past year and smoking status recorded in the past year were considered available if the patient had an MRC grade or smoking status in their patient record in the 15 months prior to the audit date. Both MRC grade and smoking status were the most recent available in the patient record. Smoking status was categorised as (see code lists ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"dqWIlWsy","properties":{"formattedCitation":"(1)","plainCitation":"(1)","noteIndex":0},"citationItems":[{"id":197,"uris":[""],"uri":[""],"itemData":{"id":197,"type":"webpage","abstract":"Documents developed to help practices participating in the national COPD primary care audit (Wales) 2015–17 navigate the process.","container-title":"RCP London","title":"National COPD primary care audit (Wales) 2015–17: resources","title-short":"National COPD primary care audit (Wales) 2015–17","URL":"","author":[{"literal":"Royal College of Physicians"}],"accessed":{"date-parts":[["2018",6,5]]},"issued":{"date-parts":[["2017",3,29]]}}}],"schema":""} (1) for codes used to define each category): current smoker, ex-smoker, or never smoker.Number of exacerbations in the past year was calculated using a validated method of detecting acute exacerbation of COPD (AECOPD) in UK primary care electronic health records ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"uZHtWTkI","properties":{"formattedCitation":"(3)","plainCitation":"(3)","noteIndex":0},"citationItems":[{"id":42,"uris":[""],"uri":[""],"itemData":{"id":42,"type":"article-journal","abstract":"Background Acute Exacerbations of COPD (AECOPD) identified from electronic healthcare records (EHR) are important for research, public health and to inform healthcare utilisation and service provision. However, there is no standardised method of identifying AECOPD in UK EHR. We aimed to validate the recording of AECOPD in UK EHR. Methods We randomly selected 1385 patients with COPD from the Clinical Practice Research Datalink. We selected dates of possible AECOPD based on 15 different algorithms between January 2004 and August 2013. Questionnaires were sent to GPs asking for confirmation of their patients’ AECOPD on the dates identified and for any additional relevant information. Responses were reviewed independently by two respiratory physicians. Positive predictive value (PPV) and sensitivity were calculated. Results The response rate was 71.3%. AECOPD diagnostic codes, lower respiratory tract infection (LRTI) codes, and prescriptions of antibiotics and oral corticosteroids (OCS) together for 5–14 days had a high PPV (>75%) for identifying AECOPD. Symptom-based algorithms and prescription of antibiotics or OCS alone had lower PPVs (60–75%). A combined strategy of antibiotic and OCS prescriptions for 5–14 days, or LRTI or AECOPD code resulted in a PPV of 85.5% (95% CI, 82.7–88.3%) and a sensitivity of 62.9% (55.4–70.4%). Conclusion Using a combination of diagnostic and therapy codes, the validity of AECOPD identified from EHR can be high. These strategies are useful for understanding health-care utilisation for AECOPD, informing service provision and for researchers. These results highlight the need for common coding strategies to be adopted in primary care to allow easy and accurate identification of events.","container-title":"PLOS ONE","DOI":"10.1371/journal.pone.0151357","ISSN":"1932-6203","issue":"3","journalAbbreviation":"PLOS ONE","page":"e0151357","source":"PLoS Journals","title":"Validation of the Recording of Acute Exacerbations of COPD in UK Primary Care Electronic Healthcare Records","volume":"11","author":[{"family":"Rothnie","given":"Kieran J."},{"family":"Müllerová","given":"Hana"},{"family":"Hurst","given":"John R."},{"family":"Smeeth","given":"Liam"},{"family":"Davis","given":"Kourtney"},{"family":"Thomas","given":"Sara L."},{"family":"Quint","given":"Jennifer K."}],"issued":{"date-parts":[["2016",3,9]]}}}],"schema":""} (3). This defines an exacerbation as either an exacerbation code, a prescription for oral corticosteroids and antibiotics on the same day, or a code for lower respiratory tract infection (LRTI). Any of these events occurring within 14 days of each other is considered part of the same exacerbation. This algorithm was used to find number of exacerbations for each patient in the year prior to the audit date, and was categorised as 0, 1, 2, or >2 exacerbations. 4 practices did not contribute data to this variable due to missing LRTI data.Inhaled therapy regimen was defined based on prescriptions that the patient had received in the 6 months prior to the audit date. Triple therapy was defined as a prescription for a long-acting β adrenoceptor agonist (LABA) + inhaled corticosteroid (ICS) and Long-acting muscarinic antagonist (LAMA) inhaler on the same day. LABA & LAMA therapy was defined as a prescription for a LABA and LAMA inhaler on the same day. Other inhaler prescriptions were defined as the most commonly received inhaler prescription (ICS, LABA, LABA & ICS, or LAMA).Receipt of the seasonal influenza immunisation was considered true if the patient had a record of the immunisation in the preceding 01/08/2016 to 31/03/2017. ................
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