SESSION TYPE: New Insights into COPD
PRESENTED ON: Monday, October 22, 2012 at 04:00 PM - 05:30 PM
PURPOSE: Clinical practice guidelines (CPGs) are issued and updated at regular intervals to improve the quality of care for patients with COPD. However, the actual implementation of these guidelines by physicians in clinical practice remains unknown. We examined the current management of stable COPD patients in our ambulatory clinics. We hypothesize that CPG’s are underutilized in management of stable COPD patients.
METHODS: Patients with at least two outpatient visits with a clinical diagnosis of COPD, confirmed by PFT criteria of FEV-1/FVC < 70, were enrolled in this study. Primary outcome was defined as under-, appropriate-, or over-treatment, according to 2010 GOLD stage-specific recommendations. Independent variables including baseline demographics, co-morbidities, inhaler therapy, and type of provider were obtained. The type of provider was classified into primary care physician (PCP), pulmonologist, or co-management by both PCP and pulmonologist. T-test and chi-square were used to compare continuous and categorical variables, respectively. We used multivariable logistic regression to examine the independent correlate of primary outcome.
RESULTS: Among 310 patients who met study criteria, 20 (6.5%) had GOLD stage I, 147 (47.4%) stage II, 104 (33.5%) stage III, and 39 (12.6%) stage IV. Ten patients, all from stage I were over-treated. Across all stages 38.4% were under-treated. There was no difference in age, gender, race, disease severity and co-morbidities between patients who received appropriate- or under- treatment. In a multivariate analysis, patients who were co-managed by PCP and pulmonologist had higher likelihood of receiving appropriate treatment (OR: 3.46, 95% CI: 1.98-6.10, p-value <0.001) compared to those managed by PCP alone.
CONCLUSIONS: Regardless of GOLD stage, at least a third of the patients with COPD were under-treated. Patients co-managed by both PCP and pulmonologist had a higher likelihood of receiving treatment according to the GOLD guidelines.
CLINICAL IMPLICATIONS: Efforts to increase awareness of clinical practice guidelines among PCP may improve management of stable COPD patients.
DISCLOSURE: The following authors have nothing to disclose: Gulshan Sharma, Roozbeh Sharif, Christel Cuevas, Yue Wang
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