The increasing incidence of COPD has lead to the publication of COPD guidelines in 1995 and recently in 2001. Although differences in quality of care and outcome between generalist and specialist have been described for patients with coronary artery disease and with asthma, no study has been reported for patients with COPD.
To determine whether care for COPD patients was more consistent with national guidelines when a specialist rather than a generalist was the usual source of care.
A retrospective record review of patients with COPD followed at the outpatient clinics during 2000-2001was done.
We had twenty patients in each group. The mean age in both the group was 70 year-old.CONCLUSIONS: Spirometry and the use of anti-cholinergics and long-acting B2 agonists are underutilized in the primary care setting compared with sub-specialty care. Thirty percent of the patients in the primary care clinic had a diagnosis of COPD without pulmonary function test confirmation. There was a tendency for patients with more severe disease to be seen at the specialty clinic which could explain the higher use of long-acting B2 agonist.
Considering that COPD is now the fourth leading cause of mortality in the United States and that generalists are the first physicians encountering most patients, it is of utmost importance to educate and share the information about evaluation, management and prevention of COPD with primary care physicians.
Generalist versus Specialist in COPD careGeneralist n=20Pulmonary Specialist n=20Smoking Cessation addressed19 (95%)20 (100%)Spirometry done14 (70%)20 (100%)FEV1 %predicted (mean)68%61%Anti-cholinergic inhalers14 (70%)17 (85%)Use Long-acting B2 agonist3 (15%)15 (75%)
G. Diaz-Fuentes, None.