Real-World COPD Management Over 3 Years at the Community Health Service Center of Shanghai During the COVID-19 Pandemic in China

International Journal of Chronic Obstructive Pulmonary Disease Dovepress open access to scientific and medical research International Journal of Chronic Obstructive Pulmonary Disease downloaded from https://www.dovepress.com/ on 30-Mar-2023 For personal use only. Open Access Full Text Article C L I N I C A L T R I A L R E P O RT Real-World COPD Management Over 3 Years at the Community Health Service Center of Shanghai During the COVID-19 Pandemic in China Ting-Ting Wu1,*, Yi Qun Jiang2,*, Bang-Feng Zhao1,*, Feng-Li Si1, Peng Wu1, Huan-Ying Wang1, Chun-Feng Sheng1, Xun Xu1, Fan Li1, Jing Zhang3 1 Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (Preparatory Stage), Shanghai, People’s Republic of China; 2General Practice/International Medical Care Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 3Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China *These authors contributed equally to this work Correspondence: Fan Li; Jing Zhang, Email ; Objective: To evaluate the real-world situation for the management of chronic obstructive pulmonary disease (COPD) and poorly controlled disease risk factors in the Chinese community. Methods: This retrospective multicentre study analysed data from COPDMICand MICHC in Shanghai Songjiang District, Shanghai, China. The differences in COPD Assessment Test (CAT), the modified Medical Research Council (mMRC) dyspnea scale, and the number of emergency cases, emergency visits, inpatient cases, and hospitalisations from January 2018 to December 2020 were analysed. The impact of coronavirus disease 2019 (COVID-19) on COPD management was also assessed. Results: For 2020 versus 2018, analysis of 468 COPD cases from COPDMIC matched with MICHC data showed significantly more patients with improved mMRC grades, significantly fewer emergency cases and emergency visits, and significantly fewer hospitalisa tion cases and hospitalisations. Differences in the number of emergency visits and hospitalisations per capita were statistically significant. Compared to GOLD 3–4, GOLD 1–2 patients showed significant improvements in CAT score, mMRC grade, the number of emergency visits and hospitalisations per capita. Treatment adherence from 2018 to 2020 was 25%, 29.1%, and 6.8%, and the proportion of medication regimens consistent with guidelines was 43.44%, 50.98%, and 71.87%, respectively. Higher treatment adherence resulted in significantly improved CAT scores and mMRC grades and fewer emergency department visits and hospitalisa tions per capita. Conclusion: Combined with remote management tools, patients with COPD achieved continuous improvement in symptoms and exacerbations over 3 years. In the context of COVID-19 prevention/control measures, improvements were significant for patients with GOLD 1–2 COPD but limited with GOLD 3–4. Pharmacologic treatment significantly improved clinical symptoms and reduced emergency visits and hospitalisations. Severe airflow limitation and poor adherence to pharmacologic treatment were important risk factors for lack of disease remission. Keywords: chronic obstructive, lung disease, COVID-19, family physician, management information center Introduction Chronic obstructive pulmonary disease (COPD) is a common respiratory disease globally. In China, the prevalence of COPD for individuals older than 40 years has increased in less than a decade, from 8.6% in 2007 to 13.7% in 2018,1,2 resulting in COPD becoming the third leading cause of disability and the fourth leading cause of mortality in China.3 Despite this high prevalence and poor outcomes, however, numerous studies have shown that the rate of early diagnosis, International Journal of Chronic Obstructive Pulmonary Disease 2023:18 349–364 Received: 1 October 2022 Accepted: 6 March 2023 Published: 17 March 2023 349 © 2023 Wu et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Dovepress Wu et al standardisation of initial treatment regimens (ie consistency of drug regimens with guidelines), and adherence to drug therapy are generally low in patients with COPD in China. For example, Wang Chen et al reported2 that only 9.7% of patients with COPD in China were diagnosed based on pulmonary function, and only 3.2% of patients with COPD had a medication regimen consistent with guidelines. A national cross-sectional survey of individuals aged 40 years and older showed a diagnosis rate of 5.9% and a treatment rate of 11.7% among those with COPD.4 In terms of treatment adherence over 1 year among patients with stable COPD in two studies, 30% were adherent for more than 50% of the year, whereas 10% were adherent for more than 80% of the year.5,6 Therefore, improving the rate of early diagnosis, treatment standardisation, and treatment adherence of patients with COPD in China is an important issue to improve the treatment outcomes in this population. To address this issue, we developed COPD Management Information Center (COPDMIC), which went online in 2017 (Figure 1).7 The COPDMIC is a regional COPD patient management platform established through the mobile Internet and Internet of Things, which unites family physicians from 21 community health service centres and respiratory specialists from three general hospitals in Songjiang District, Shanghai, China. Family physicians are responsible for screening high-risk groups for COPD, managing patients with stable disease and after treatment, referral for COPD acute exacerbations, and patient health education, among other services. Respiratory specialists are responsible for the diagnosis of COPD, treatment plan formulation, two-way referral for patients with acute exacerbations, and addressing challenges encountered by family physicians in the diagnosis and treatment of COPD. Since the platform began operating Figure 1 Flow chart of COPDMIC operations. 350 Powered by TCPDF (www.tcpdf.org) https://doi.org/10.2147/COPD.S391908 DovePress International Journal of Chronic Obstructive Pulmonary Disease 2023:18 Dovepress Wu et al in 2017, we have sought to understand the real-world situation of COPD management in the community. To this end, our current study is a retrospective analysis of the platform data over 3 years, from 2018 to 2020. During our (...truncated)