Rachel E Jordan

Rachel E Jordan
University of Birmingham · Department of Public Health, Epidemiology and Biostatistics

About

127
Publications
13,221
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
4,924
Citations

Publications

Publications (127)
Article
Full-text available
Respiratory diseases remain a significant cause of global morbidity and mortality and primary care plays a central role in their prevention, diagnosis and management. An e-Delphi process was employed to identify and prioritise the current respiratory research needs of primary care health professionals worldwide. One hundred and twelve community-bas...
Article
Objectives: To assess the feasibility of delivering a culturally tailored pulmonary rehabilitation (PR) programme and conducting a definitive randomised controlled trial (RCT). Design: A two-arm, randomised feasibility trial with a mixed-methods process evaluation. Setting: Secondary care setting in Georgia, Europe. Participants: People with...
Article
Introduction: Work-related asthma (WRA) refers to asthma caused by exposures at work (occupational asthma) and asthma made worse by work conditions (work-exacerbated asthma). WRA is common among working-age adults with asthma and impacts individual health, work-life and income but is often not detected by healthcare services. Earlier identificatio...
Article
Full-text available
COPD is increasingly common in China but is poorly understood by patients, medications are not used as prescribed and there is no access to recommended non-pharmacological treatment. We explored COPD patients’ and general practitioners’ (GPs) knowledge of COPD, views on its management and the acceptability of a flexible lung health service (LHS) of...
Article
Full-text available
Background Staff absenteeism and presenteeism incur high costs to the NHS and are associated with adverse health outcomes. The main causes are musculoskeletal complaints and mental ill-health, which are potentially modifiable, and cardiovascular risk factors are also common. We will test the feasibility of an RCT to evaluate the clinical and cost-e...
Article
Full-text available
Background Chronic obstructive pulmonary disease is a major contributor to morbidity, mortality and health service costs but is vastly underdiagnosed. Evidence on screening and how best to approach this is not clear. There are also uncertainties around the natural history (prognosis) of chronic obstructive pulmonary disease and how it impacts on wo...
Article
Full-text available
Objectives To examine the accuracy and cost-effectiveness of various chronic obstructive pulmonary disease (COPD) screening tests and combinations within a Chinese primary care population. Design Screening test accuracy study. Setting Urban and rural community health centres in four municipalities of China: Beijing (north), Chengdu (southwest), G...
Conference Paper
Introduction and Objectives The accuracy of available screening questionnaires for undiagnosed COPD in low/middle income country settings is unknown. We compared test performance of a variety of instruments in Brazil and China. Methods Patients aged ≥40 years from community health centres in China, and hypertension clinics in Basic Health Units in...
Article
Full-text available
Microspirometry may be useful as the second stage of a screening pathway among patients reporting respiratory symptoms. We assessed sensitivity and specificity of the Vitalograph® lung monitor compared with post-bronchodilator confirmatory spirometry (ndd Easy on-PC) among primary care chronic obstructive pulmonary disease (COPD) patients within th...
Article
Full-text available
Objectives: To investigate the impact of chronic obstructive pulmonary disease (COPD) case finding on clinical care. Design: We conducted a prospective observational analysis of data from a pragmatic cluster randomised controlled trial in primary care in the West Midlands, UK (TargetCOPD). This compared alternative methods of COPD case finding a...
Article
Full-text available
Background Pulmonary rehabilitation (PR) is a cost-effective, internationally recommended intervention for patients with chronic obstructive pulmonary disease (COPD). Referral is predominately led by primary healthcare practitioners (PHCPs), but referral and patient uptake is poor. Aim To understand barriers and enablers for PHCPs when considering...
Article
Full-text available
Background: Reviews suggest that the ADO score is the most discriminatory prognostic score for predicting mortality among chronic obstructive pulmonary disease (COPD) patients, but a full evaluation and external validation within primary care settings is critical before implementation. Objectives: To validate the ADO score in prevalent and scree...
Article
Full-text available
Background: Good quality information is critical for valid informed consent to trials, but current paper-based consent procedures are potentially unwieldy and can be difficult to comprehend, which may deter people from participating. Multimedia resources may be able to provide more accessible and user-friendly information. We aimed to test whether...
Article
Full-text available
Introduction ‘One-off’ systematic case-finding for COPD using a respiratory screening questionnaire is more effective and cost-effective than routine care at identifying new cases. However, it is not known whether early diagnosis and treatment is beneficial in the longer term. We estimated the long-term cost-effectiveness of a regular case-finding...
Article
Full-text available
COPD self-management reduces hospital admissions and improves health-related quality of life (HRQoL). However, whilst most patients are managed in primary care, the majority of self-management trials have recruited participants with more severe disease from secondary care. We report the findings of a systematic review of the effectiveness of commun...
Article
Full-text available
Objective: To evaluate the effectiveness of telephone health coaching delivered by a nurse to support self management in a primary care population with mild symptoms of chronic obstructive pulmonary disease (COPD). Design: Multicentre randomised controlled trial. Setting: 71 general practices in four areas of England. Participants: 577 patie...
Data
Supplementary materials: Outline of the intervention components
Data
Supplementary materials: Accelerometry methods and adherence
Data
Supplementary materials: Results of sensitivity analyses for the PSM-COPD study
Article
Full-text available
Background: Consensus on the definition of airflow obstruction to diagnose COPD remains unresolved. Methods: We undertook systematic case finding for COPD in primary care using the fixed ratio (FR) criterion (forced expiratory volume in 1 s/forced vital capacity [FEV1/FVC] <0.7) for defining airflow obstruction and also using the lower limit of...
Article
Full-text available
Background COPD is a leading cause of morbidity and mortality, yet it remains largely under-diagnosed. Case-finding is encouraged by many professionals, but there is a lack of information on the patients’ views and perspectives. Patients and methods Semistructured interviews were conducted with adults, aged 40 years or older with a history of smok...
Article
Objective: To evaluate the effectiveness of nurse-led telephone health coaching to encourage self-management in a primary care population with mild symptoms of COPD. Design: Pragmatic, multi-centre randomised controlled trial. Setting: 71 general practices in four areas of England. Participants: 577 people, with MRC dyspnoea grade 1 or 2, recruited...
Article
Full-text available
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To determine the effectiveness of interventions to increase patient referral, uptake, and adherence to pulmonary rehabilitation programmes, for patients with COPD.
Article
Background Patients with chronic obstructive pulmonary disease (COPD) are more likely to take time off work (absenteeism) and report poor performance at work (presenteeism) compared to those without COPD. Little is known about the modifiable factors associated with these work productivity outcomes. Aim To assess the factors associated with work pr...
Article
Chronic obstructive pulmonary disease (COPD) is greatly underdiagnosed worldwide and more efficient methods of case-finding are required. We developed and externally validated a risk score to identify undiagnosed COPD using primary care records. We conducted a retrospective cohort analysis of a pragmatic cluster randomised controlled case-finding t...
Article
Full-text available
Background Employment rates among those with chronic obstructive pulmonary disease (COPD) are lower than those without COPD, but little is known about the factors that affect COPD patients’ ability to work. Methods Multivariable analysis of the Birmingham COPD Cohort Study baseline data was used to assess the associations between lifestyle, clinic...
Article
Full-text available
Introduction Noninvasive ventilation (NIV) improves survival among patients with hypercapnic respiratory failure in hospital, but evidence for its use in domiciliary settings is limited. A patient’s underlying risk of having an exacerbation may affect any potential benefit that can be gained from domiciliary NIV. This is the first comprehensive sys...
Article
Chronic obstructive pulmonary disease (COPD) affects 5–10% of people worldwide, 1 is rising in prevalence 2 and is the third most common cause of death. 3 The annual burden of COPD regarding healthcare (mainly exacerbations resulting in emergency admissions) and societal (predominantly lost productivity) costs was estimated to be around $49.9 billi...
Article
Background: Many individuals with chronic obstructive pulmonary disease (COPD) remain undiagnosed worldwide. Health-care organisations are implementing case-finding programmes without good evidence of which are the most effective and cost-effective approaches. We assessed the effectiveness and cost-effectiveness of two alternative approaches to ta...
Article
Full-text available
Purpose This systematic review aimed to identify the most effective components of interventions to facilitate self-management of health care behaviors for patients with COPD. PROSPERO registration number CRD42011001588. Methods We used standard review methods with a systematic search to May 2012 for randomized controlled trials of self-management...
Data
HRQoL (CRQ) at final follow-up for comparisons assessing the effects of one additional component of self-management. Note: D = rehabilitation (traditional and modern) + qigong + breathing training + limb training vs modern rehabilitation + breathing training + limb training. Abbreviations: ANCOVA, analysis of covariance; CI, confidence interval; HR...
Data
Hospital admissions for multicomponent self-management interventions versus usual care. Notes: B = exercise vs control. ^Several papers are represented by this lead publication. Abbreviations: ANCOVA, analysis of covariance; CI, confidence interval; HR, hazard ratio.
Data
HRQoL (CRQ) outcomes for multicomponent self-management intervention versus usual care. Note: A = rehabilitation (traditional and modern) + qigong + breathing training + limb training vs UC. Abbreviations: ANCOVA, analysis of covariance; CI, confidence interval; HRQoL, health-related quality of life; CRQ, Chronic Respiratory disease Questionnaire;...
Data
HRQoL (SGRQ) at final follow-up for comparisons assessing the effects of one additional component of self-management. Abbreviations: ANCOVA, analysis of covariance; CI, confidence interval; HRQoL, health-related quality of life; SGRQ, St George’s respiratory questionnaire; Int, intervention group; Cont, control group.
Data
HRQoL (SGRQ) outcomes for multicomponent self-management interventions including supervised exercise versus usual care/control. Notes: B = exercise vs control. ^Several papers are represented by this lead publication. Abbreviations: ANCOVA, analysis of covariance; CI, confidence interval; HRQoL, health-related quality of life; SGRQ, St George’s res...
Data
HRQoL (SGRQ) outcomes for exercise-only interventions versus usual care/sham intervention. Note: *The control group that has been halved in size (split between two comparisons). A = t’ai chi qigong vs control. B = exercise vs control. Abbreviations: ANCOVA, analysis of covariance; CI, confidence interval; HRQoL, health-related quality of life; SGRQ...
Data
HRQoL (CRQ) outcomes for multicomponent self-management interventions including supervised exercise versus usual care/control. Note: A = rehabilitation (traditional and modern) + qigong + breathing training + limb training vs UC. Abbreviations: ANCOVA, analysis of covariance; CI, confidence interval; HRQoL, health-related quality of life; CRQ, Chro...
Data
HRQoL (SGRQ) outcomes for multicomponent self-management interventions with structured, unsupervised exercise versus usual care/control. Abbreviations: ANCOVA, analysis of covariance; CI, confidence interval; HRQoL, health-related quality of life; SGRQ, St George’s respiratory questionnaire.
Data
HRQoL (SGRQ) outcomes for multicomponent self-management interventions without an exercise element versus usual care/control. Notes: *The control group that has been halved in size (split between two comparisons). A = nurse-assisted collaborative management vs UC; B = nurse-assisted medical management vs UC. Abbreviations: ANCOVA, analysis of covar...
Data
HRQoL (SGRQ) outcomes for multicomponent self-management interventions with exercise counseling only versus usual care/control. Note: ^Several papers are represented by this lead publication. Abbreviations: ANCOVA, analysis of covariance; CI, confidence interval; HRQoL, health-related quality of life; SGRQ, St George’s respiratory questionnaire.
Article
Full-text available
Hospitalisations for severe exacerbations of chronic obstructive pulmonary disease are associated with significant physical and psychological consequences including an increase in symptom severity, severe reductions in physical activity, a deleterious effect on skeletal muscle, impaired exercise tolerance/ability to self-care, decline in quality of...
Article
Full-text available
Background Chronic obstructive pulmonary disease (COPD) is widely underdiagnosed. A number of studies have evaluated the accuracy of screening tests for COPD, but their findings have not been formally summarised. We therefore sought to determine and compare the diagnostic accuracy of such screening tests in primary care. Methods Systematic review a...
Article
Full-text available
Background Chronic obstructive pulmonary disease (COPD) is a chronic progressive lung disease characterised by non-reversible airflow obstruction. Exacerbations are a key cause of morbidity and mortality and place a considerable burden on health-care systems. While there is evidence that patients benefit from non-invasive ventilation (NIV) in hospi...
Article
Introduction: Over diagnosis is a growing concern for a wide range of diseases. We aimed to assess the magnitude of COPD over-diagnosis in the UK primary care settings and examine the characteristics of patients potentially over-diagnosed with COPD. Methods: We analysed data on 1,473 GP diagnosed COPD patients aged 40 years and over who participate...
Article
Full-text available
Background: Chronic obstructive pulmonary disease (COPD) is widely underdiagnosed, but the most effective approach for identifying these patients is unknown. Aims: The aim of this study was to summarise and compare the effectiveness of different case finding approaches for undiagnosed COPD in primary care. Methods: A systematic review of prima...
Article
Full-text available
Self-management (SM) support for patients with chronic obstructive pulmonary disease (COPD) is variable in its coverage, content, method and timing of delivery. There is insufficient evidence for which SM interventions are the most effective and cost-effective. Objectives To undertake (1) a systematic review of the evidence for the effectiveness o...
Article
Full-text available
Although many hospitals promote self-management to chronic obstructive pulmonary disease (COPD) patients post discharge from hospital, the clinical effectiveness of this is unknown. We undertook a systematic review of the evidence as part of a Health Technology Assessment review. A comprehensive search strategy with no language restrictions was con...
Article
Full-text available
To develop and validate a clinical risk score to identify patients at risk of chronic obstructive pulmonary disease (COPD) using clinical factors routinely recorded in primary care. Case-control study of patients containing one incident COPD case to two controls matched on age, sex and general practice. Candidate risk factors were included in a con...
Article
Full-text available
The prevalence of diagnosed chronic obstructive pulmonary disease (COPD) in the UK is 1.8%, although it is estimated that this represents less than half of the total disease in the population as much remains undiagnosed. Case finding initiatives in primary care will identify people with mild disease and symptoms. The majority of self-management tri...
Article
Full-text available
Background NIV is very effective when used acutely in hospital during acute exacerbations of COPD, however, evidence supporting its use in a home setting for more stable COPD patients is limited. In the UK domiciliary NIV is considered by many clinicians on health economic grounds in patients after three hospital admissions for acute hypercapnic re...
Article
This abstract summarises independent research funded by the National Institute for Health Research (NIHR) under its HTA Programme (Ref 11/27/01). The views expressed are those of the author (s) and not necessarily those of the NHS, the NIHR or the Department of Health. Background Self-management interventions delivered to COPD patients at discharge...
Article
Introduction There is evidence that workplace productivity may be impaired among working patients with COPD. Occupational health (OH) interventions have been effective in improving work productivity in other chronic conditions. However, little is known about the feasibility and acceptability of such interventions among those with COPD. Aim To asses...
Article
Full-text available
Background: Many people with clinically significant chronic obstructive pulmonary disease (COPD) remain undiagnosed worldwide. There are a number of small studies which have examined possible methods of case finding through primary care, but no large RCTs that have adequately assessed the most cost-effective approach. Methods/design: In this stu...