PURPOSE: Our goals were to: 1) assess adherence to American Thoracic Society (ATS) guidelines for COPD along with the quality of life of COPD patients in Internal Medicine (IM) and Family Medicine (FM) Residency clinics 2) implement educational changes and reassess adherence to guidelines and patients’ quality of life.
METHODS: Baseline data was collected from 182 charts from both clinics for demographics, co-morbidities and compliance with eight recommendations of the ATS for COPD care. Quality of life was assessed using a validated questionnaire for 42 IM patients with COPD. After nine months, 100 charts were reviewed to reassess compliance and 35 patients were resurveyed for quality of life.
RESULTS: Pre-intervention data from IM vs. FM showed clinical assessment of COPD was documented in 73% vs. 62%, oxygen evaluation in 72% vs. 31%, smoking counseling in 57% vs. 91%, referral to a pulmonologist in 70% vs. 47%, referral to pulmonary rehabilitation in 30% vs. 9%, and an appropriate end of life discussion in 26% vs. 5%. COPD staging was done in only 60% vs. 54%, and assessment of weight loss 45% vs. 9% in IM and FM clinics respectively. Post intervention data from the IM clinic showed statistically significant improvement in adherence to guidelines except for end of life counseling, smoking cessation, and weight loss assessment. Post intervention data in FM showed improvement only in end of life discussions, oxygen evaluation, and pulmonary rehab referrals. The baseline quality of life data showed that Physical and Mental Health scores were low, at 32 and 44. Follow up assessment showed slight improvement in the mental score (46) and worsening of the physical score (31). Quality of life data for FM is pending.
CONCLUSIONS: Our results show poor compliance with the ATS guidelines at baseline. Even with improved adherence to guidelines the quality of life of IM patients did not improve.
CLINICAL IMPLICATIONS: This opens discussions regarding the resources devoted to improving guideline compliance and what it means for patient outcomes.
DISCLOSURE: The following authors have nothing to disclose: Ali Eskandar, Jami Foreback, Ragnhild Bundesmann, Tahera Azharuddin, Hilana Hatoum, Vidya Kollu, Harish Nuthakki, Ashvin Tadakamalla, Divya Thomas, Ramesh Yarlagadda, Mohamed Mansour, Scott Plensdorf, Hossam Hafez, Paul Lazar
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