The challenge of multimorbidity in primary care patients with obstructive lung disease

Multimorbid primary care patients with asthma or chronic obstructive pulmonary disease (COPD) may receive suboptimal care, with adverse outcomes including exacerbations, mortality, morbidity, hospital admission, polypharmacy and sick-leave.

Primary care patient management aspects that ameliorate these risks will be identified, such as specific treatment patterns, continuity of care and tackling polypharmacy.

The longitudinal PRAXIS asthma and COPD cohorts include 1,111 patients with COPD and 1,100 with asthma from 2005 in central Sweden and a further 1,800 with COPD and 1,200 with asthma in 2014/2015, with questionnaire and record review follow-up to 2022.

In the first year, PRAXIS will be extended with a 10-1 matched reference cohort and linkage with several registers covering health and socioeconomic characteristics and analysed for the following two years.

Primary care registers covering Stockholm and Västra Götaland (over 4 million individuals) linked with other registers will also be used over the three years of the project.

Patterns of multimorbidity and their associations with adverse outcomes estimated using methods including Cox regression, logistic/multinomial regression and flexible parametric models.

Multi-level modelling will be used for examining the putative primary care ameliorating factors to address heterogeneity in patients and resources between the primary care centres. The resulting information will help to improve management of an at-risk patient group.