Positive Outcomes Observed Among Those With COPD in Nurse, Allied Health–Led Clinic

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Individuals using the Nurse and Allied Health Clinic–Respiratory Care (NAHC-Respiratory) in Hong Kong—a nurse- and allied health-led primary care clinic—saw improvements in chronic obstructive pulmonary disease (COPD) outcomes and diminished hospital service use, according to new findings.¹

This research was led by Kailu Wang, PhD, from the Centre for Health Systems and Policy Research at the Chinese University of Hong Kong’s JC School of Public Health and Primary Care in China. Wang et al. wrote that individuals in Hong Kong with COPD within primary care clinics are included in a multidisciplinary program known as the Nurse and Allied Health Clinic–Respiratory Care (NAHC-Respiratory), for primary care clinics of the public sector established in 2009.²

“...(It) is important to find out whether this primary care intervention can save precious health care resources in the secondary and tertiary care settings,” Wang and colleagues wrote. “Therefore, this study aimed to examine the association between attending NAHC-Respiratory and risk of mortality, incidence of comorbidity and complications, and health care service use during a more than 6-year follow-up period.”¹

Background and Design

The investigators conducted their research using a population-based, retrospective cohort design which was labeled ‘territory-wide’ given its location in Hong Kong, China. They implemented electronic health records which were drawn from all individuals who had been using public health services in Hong Kong.

The study’s subjects had COPD and had been treated within public outpatient clinics between January 2010 - December 2014. The NAHC-Respiratory program was what this cohort was based upon, a program which is 1 of 6 under the NAHC and aimed at the monitoring of ambulatory adult COPD patients in Hong Kong.

NAHC-Respiratory was formed within Hong Kong’s public sector family medicine and general outpatient clinics. Primarily, physiotherapists, nurses, and occupational therapists are involved in this program, with patients being deemed to have completed the program if they have attended at least 75% of the education sessions.

In the NAHC-Respiratory program, health care professionals work to evaluate COPD patient’s spirometry both with and without bronchodilator reversibility testing. They also assess these individuals’ respiratory symptoms through the use of instruments such as a modified Medical Research Council Dyspnea Scale, the COPD Assessment Test, and the 6-minute walk test. The program also refers such individuals to different services as necessary and examines their prior history of exacerbations.

These patients are given a discharge and then potential community services/telephone follow-up provided that they have normal lung function or completed the 6- and 12-month assessments deemed as necessary following program intake following a COPD diagnosis. Those participating in the program were also given treatment by clinicians in outpatient clinical settings as per usual care.

NAHC-Respiratory attendants as well as individuals given usual care only were matched using a 1:2 ratio during the course of the research, with investigators implementing propensity scores. The research team conducted their data analyses in the timeframe between August 2023 - April 2024.

The primary exposure used in this analysis was attendance at NAHC-Respirator, and the research team compared all-cause and cause-specific mortality. They also compared the incidence of complications related to COPD, and the use of emergency department and inpatient services until the end of 2019 between the NAHC-Respiratory attendees and those receiving usual care.

Findings

Overall, there were 9,048 eligible subjects included in the team’s research. They were divided into 3,093 individuals within the exposure cohort, 91.0% of which were men and the mean age of which was 69.8 years). There were 5,955 subjects featured in the reference cohort, with 91.2% being men and the mean age of the group being 69.5 years.

Those in the exposure arm were reported by the investigators to have decreased risks of pneumonia-caused mortality (HR, 0.85), all-cause mortality (hazard ratio [HR], 0.84), respiratory-caused mortality (HR, 0.86), and cardiovascular-related mortality (HR, 0.74) versus individuals featured in the usual care-only arm of the study.

Furthermore, the research team noted that exposure was shown to be associated with diminished emergency department visit rates (incidence rate ratio [IRR], 0.92). It was also linked to diminished rates of hospitalization through emergency departments (IRR, 0.89).

“The program components can be considered in addition to usual care or can be used to inform the design of other related programs to benefit more patients,” they wrote. “In the future, experimental studies can be conducted to examine the program’s effectiveness on health outcomes, and implementation science studies can be considered to improve its service delivery.”

References

1. ^{Wang K, Zhao S, Yau SZ, et al. Outcomes and Hospital Service Use Among Patients With COPD in a Nurse- and Allied Health–Led Clinic. JAMA Health Forum. 2024;5(7):e241575. doi:10.1001/jamahealthforum.2024.1575.}
2. ^{Chin WY, Lam CL, Lo SV. Quality of care of nurse-led and allied health personnel-led primary care clinics. Hong Kong Med J. 2011;17(3):217-230.}