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Education, Teaching, and Quality Improvement |

Compliance With Recommended Nonpharmacological Management in COPD Patients

Navitha Ramesh, MD; Waleed Quwatli, MD; Neelima Divakaran, MD; Ruth Kouides, MD
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Unity Health System, Rochester, NY


Chest. 2013;144(4_MeetingAbstracts):526A. doi:10.1378/chest.1703537
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Abstract

SESSION TITLE: Clinical Improvement Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: To determine the rates of smoking cessation counseling, pulmonary rehabilitation referral, and influenza and pneumococcal vaccination in COPD patients.

METHODS: We performed a retrospective chart review of PFT-confirmed COPD patients (ICD 496) seen at our resident-faculty practice. Patient demographics, smoking status and counseling, pneumococcal and influenza vaccine administration rates and pulmonary rehabilitation referrals were collected and analyzed.

RESULTS: Of the 335 patients with COPD ICD code 496, 61 patients were confirmed to have COPD based on pulmonary function tests. Thirty one percent (19/61) were current smokers and 100% of these were counseled regarding smoking cessation. Based on FEV1, 16.4% (10/61) were GOLD Class 1, 57.4% (35/61) were GOLD Class 2, 24.6% (15/61) with GOLD Class 3 and 1.6% (1/61) were GOLD Class 4. By FEV1 Class, 26.2% (16/61) were eligible for pulmonary rehabilitation. Of these, 37.5% (6/16) patients were referred, 31.3% (5/16) were not referred because of current smoking status, 6.3% (1/16) were lost to follow up and 25% (4/16) had no documentation regarding referral. Regarding immunization status, 64% (39/61) received annual influenza vaccine and 78.7% (48/61) received pneumococcal vaccine.

CONCLUSIONS: About 30% of our COPD patients continue to smoke despite 100% cessation counseling. Only 37.5% of our eligible COPD patients were referred for pulmonary rehabilitation. Our influenza and pneumococcal immunization rates were 64% and 79%, respectively.

CLINICAL IMPLICATIONS: Smoking cessation slows the decline in FEV1 in COPD patients. Pulmonary rehabilitation reduces hospitalizations and improves the quality of life in this population. According to the latest ATS/ACP guidelines, pulmonary rehabilitation services are recommended for symptomatic COPD patients with FEV1<50 percent of predicted and we fall short of this target. The Healthy People 2020 Goals set by the US Department of Health and Human Sciences include annual influenza vaccination rate of 90% and pneumococcal vaccination rate of 60% in high-risk populations such as COPD. Our practice attained the pneumococcal immunization goal but not that for influenza immunization.

DISCLOSURE: The following authors have nothing to disclose: Navitha Ramesh, Waleed Quwatli, Neelima Divakaran, Ruth Kouides

No Product/Research Disclosure Information


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