Article Text


Organisation of respiratory care
P227 Disparities in care of adult CF patients in the UK
  1. M Salako1,
  2. S J MacNeill2,
  3. E Gunn3,
  4. M Baker3,
  5. D Bilton4,
  6. P Cullinan2
  1. 1Imperial College, London, UK
  2. 2National Heart and Lung Institute (Imperial College), London, UK
  3. 3Cystic Fibrosis Trust, Bromley, UK
  4. 4Royal Brompton Hospital, London, UK


Background Studies in the late ‘80s and early ‘90s suggested that survival in UK CF patients was better in those from non-manual social classes and that adults attending specialist clinics (66% of the total) received more intensive care. Twenty years on, we assessed whether treatments and outcomes varied by specialist care and the socio-economic status (SES) of patients.

Methods The CF Trust provided 2008 annual review data for patients attending UK adult clinics (n=3182). Three models of care were identified: “centre”, “shared” between specialist and non-specialist clinics and non-specialist “stand-alone”. SES was estimated by Townsend scores at CAS ward level. Distance to clinic was calculated as the distance between the patients’ home postcode and that of their clinic.

Results In 2008 most patients received “centre care” (94%) and few received “stand-alone care” (4%). There were no differences in rates of dornase alfa, pancreatic enzyme or IV antibiotic treatment between models. The highest rates of chronic Pseudomonas aeruginosa (PA) infections were in patients attending “centre care” (“centre” 62%: “shared” 56%: “stand-alone” 49%; p=0.01) but there were no differences in FEV1%predicted. Most patients (91%) lived <50 miles of their clinic; the distribution of clinics broadly reflected that of patients. Although those living near their clinic were less likely to be using dornase alfa (<50 miles 43%: ≥50 miles 52%, p=0.003), there were no differences in chronic Pa infection or FEV1% predicted. There were more patients than expected in the least deprived quintile of SES (30%) and fewer in the most deprived (10%). There was a decreasing trend in dornase α treatment with increasing deprivation (least deprived 48%: 43%: 41%: 41%: most deprived 42%, p=0.004) although when stratified by disease severity this was only significant among patients with mild disease (70% ≤FEV1% predicted <90%). There were no differences in chronic Pa infections or FEV1% predicted.

Conclusion In the last 20 years, the proportion of adults attending specialist clinics has increased and the majority live near their clinics. Despite these improvements, there exist disparities in treatment by distance and SES and chronic Pa infections by model of care.

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