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Physician Specialty as a Source of Heterogeneity in the Care of Patients With COPDSpecialty-Related Approaches to COPD FREE TO VIEW

Luciana Paladini, MD; Rick Hodder, MD; Vincenzo Bellia, MD, FCCP; Niccolò Marchionni, MD; Mauro Di Bari, MD,PhD; Isabella Cecchini; Riccardo Pistelli, MD; Raffaele Antonelli-Incalzi, MD
Author and Funding Information

From the Department of Geriatrics (Drs Paladini and Antonelli-Incalzi), University Campus Bio-Medico; Department of Medicine (Dr Hodder), University of Ottawa; Biomedical Department of Internal and Specialized Medicine DIBIMIS (Dr Bellia), University of Palermo; Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatric Medicine (Drs Marchionni and Di Bari), University of Florence; HealthCare Research Department (Ms Cecchini), GFK Eurisko; and Department of Pneumology (Dr Pistelli), Catholic University of Rome.

Correspondence to: Luciana Paladini, MD, Department of Geriatrics, University Campus Bio-Medico, Via Alvaro del Portillo 21, Rome 00127, Italy; e-mail: l.paladini@yahoo.it

Rows indicate actual group membership; columns indicate functional group membership.

Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Funding/Support: This study was supported by an unrestricted educational grant from Boehringer-Ingelheim GmbH and Pfizer Inc.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Funding/Support: This study was supported by an unrestricted educational grant from Boehringer-Ingelheim GmbH and Pfizer Inc.

Funding/Support: This study was supported by an unrestricted educational grant from Boehringer-Ingelheim GmbH and Pfizer Inc.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


Chest. 2011;140(6):1666-1667. doi:10.1378/chest.11-1690
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Patients with COPD frequently are cared for by nonrespiratory specialists, and specialty might affect the approach to COPD.1,2 The Linking Innovation and Knowledge in COPD (LINK) study comparatively assessed the clinical practice of three categories of Italian specialist physicians: 80 pneumologists, 81 geriatricians, and 82 internists completed an online questionnaire (e-Appendix 1) that explored these specialists’ perceptions of COPD on the basis of individual experience and professional course. Data were analyzed by descriptive statistics, and discriminant analysis was used to compare the approach to COPD of the three specialist groups.3,4 Pneumologists were more aware of specific pathophysiologic aspects of COPD, such as the clinical impact of dynamic hyperinflation (pneumologists, 86%; geriatricians, 54%; internists, 61%) and the phenotypic variants of COPD. Geriatricians more frequently performed multidimensional assessment of patients with COPD (geriatricians, 76.5%; pneumologists, 24%; internists, 28%). COPD-specific health status indexes were routinely used by 54% of pneumologists, 57% of geriatricians, and 45% of internists. Seventy-five percent of geriatricians routinely assessed activities of daily living and instrumental activities of daily living compared with 35% of pneumologists and 39% of internists.

Results from the discriminant analysis are summarized in Table 1. The first discriminant function explained 92% of the variance and had a small Wilks λ (ie, only a small proportion of the variance among groups is not explained by differences among groups). A high eigenvalue further testifies to the strong discriminant power of function 1. The cross-tabulation of actual group membership as defined by the selection criteria and functional group membership resulting from the performance on the questionnaire are reported in Table 2. The majority of geriatricians (84%) and pneumologists (71%) had concordant actual and functional group membership (ie, in their daily practice, they conformed to a highly prevalent group-specific pattern). The same was not true for internists, where only 39% behaved as internists, 40% as pneumologists, and 21% as geriatricians.

Table Graphic Jump Location
Table 1 —Canonical Discriminant Function
Table Graphic Jump Location
Table 2 —Cross-Tabulation of Actual Group Membership vs Functional Group Membership

Rows indicate actual group membership; columns indicate functional group membership.

A specialty-related approach to COPD characterized the majority of pneumologists and geriatricians and was related to distinctive visions of physiopathology, health status, comorbidity, and modality of assessment of patients with COPD. The attitude of internists toward COPD was highly heterogeneous. Our findings identify selected weaknesses and strengths of the various management styles and might suggest strategies to improve specialty practice as it pertains to COPD management.

Role of sponsors: This grant was used to support the study and does not entitle the grantors to any promotional opportunities or exhibit space. The sponsor had no role in the design of the study, the collection and analysis of the data, or in the preparation of the manuscript.

Other contributions: The authors express their gratitude to GFK Eurisko, a market research organization operating in Italy, for the development of the questionnaire, recruiting physicians, and collecting data. GFK Eurisko received funding from Boehringer-Ingelheim GmbH and Pfizer Inc.

Additional information: The e-Appendix can be found in the Online Supplement at http://chestjournal.chestpubs.org/content/140/6/1666/suppl/DC1.

Role of sponsors: This grant was used to support the study and does not entitle the grantors to any promotional opportunities or exhibit space. The sponsor had no role in the design of the study, the collection and analysis of the data, or in the preparation of the manuscript.

Other contributions: The authors express their gratitude to GFK Eurisko, a market research organization operating in Italy, for the development of the questionnaire, recruiting physicians, and collecting data. GFK Eurisko received funding from Boehringer-Ingelheim GmbH and Pfizer Inc.

Additional information: The e-Appendix can be found in the Online Supplement at http://chestjournal.chestpubs.org/content/140/6/1666/suppl/DC1.

Bourbeau J, Sebaldt RJ, Day A, et al. Practice patterns in the management of chronic obstructive pulmonary disease in primary practice: the CAGE study. Can Respir J. 2008;151:13-19 [PubMed]
 
Garcia-Aymerich J, Escarrabill J, Marrades RM, Monsó E, Barreiro E, Antó JM. EFRAM Investigators Differences in COPD care among doctors who control the disease: general practitioner vs. pneumologist. Respir Med. 2006;1002:332-339 [CrossRef] [PubMed]
 
Altman DG. Practical Statistics for Medical Research. 1991; London, England Chapman and Hall
 
Norusis MJ. Predicting cure and credit: discriminant analysis. SPSS/PC+ Advanced Statistic V2.0. 1988; Chicago, IL SPSS Inc:B1-B39
 

Figures

Tables

Table Graphic Jump Location
Table 1 —Canonical Discriminant Function
Table Graphic Jump Location
Table 2 —Cross-Tabulation of Actual Group Membership vs Functional Group Membership

Rows indicate actual group membership; columns indicate functional group membership.

References

Bourbeau J, Sebaldt RJ, Day A, et al. Practice patterns in the management of chronic obstructive pulmonary disease in primary practice: the CAGE study. Can Respir J. 2008;151:13-19 [PubMed]
 
Garcia-Aymerich J, Escarrabill J, Marrades RM, Monsó E, Barreiro E, Antó JM. EFRAM Investigators Differences in COPD care among doctors who control the disease: general practitioner vs. pneumologist. Respir Med. 2006;1002:332-339 [CrossRef] [PubMed]
 
Altman DG. Practical Statistics for Medical Research. 1991; London, England Chapman and Hall
 
Norusis MJ. Predicting cure and credit: discriminant analysis. SPSS/PC+ Advanced Statistic V2.0. 1988; Chicago, IL SPSS Inc:B1-B39
 
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