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How Accurate Is GOLD Guideline Adherence and Treatment in Primary Care? FREE TO VIEW

Stephen Eikermann, DO; Timothy Murphy, DO; Antonio Guzman, MD; David Vanderheiden, DO; Chinthaka Bulathsinghala, MD; Salim Surani, MD
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Corpus Christi Medical Center, Corpus Christi, TX

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):838A. doi:10.1016/j.chest.2016.08.938
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SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: COPD is one of the leading causes of death in the United States and over 12 million people are living with the disease. On top of the annual direct health care costs of $36 billion, COPD readmissions are being penalized making accurate diagnosis and appropriate treatment vital to decreasing the financial burden.

METHODS: Local IRB approval was obtained before performing a chart review of all patients with COPD in two primary care offices. Baseline demographics, history of exacerbations, subjective questionnaires including the CAT and mMRC, use of spirometry and all medications prescribed were recorded.

RESULTS: Chart review of 100 patients with the diagnosis of COPD in two primary care community clinics was completed (51 Male; 49 Female). Average age was 70.81 (+/-12.31) years and 24% (24/100) had exacerbations in the last year. Only 22% (22/100) had spirometry accessible in their chart. No subjective patient risk assessment using the CAT or mMRC subjective tests were done in any patients (0/100). Stratification based on spirometry using even older GOLD guidelines revealed only 27.27% (6/22) of patients were on appropriate treatment for their corresponding category of COPD. Of these, 18.18% (4/22) were on first line therapy and 9.10% (2/22) were on an acceptable alternate therapy. 27.27% (6/22) of patients were mislabeled with the diagnosis of COPD.

CONCLUSIONS: Since the utilization of subjective questionnaires is necessary to correctly categorize patients according to the 2011 GOLD guidelines, the complete lack of their utilization precludes any accurate diagnosis. Even using the outdated GOLD guidelines to stratify patients, the majority of patients were not receiving the correct medications for the severity of their COPD. Nearly one third of patients receive inappropriate medications and another third were mislabeled with the diagnosis of COPD.

CLINICAL IMPLICATIONS: Adequate treatment of patients with COPD greatly depends on the accuracy of diagnosis. Efforts must be undertaken to educate the primary care physicians about the current GOLD guideline and follow through to assess implementation.

DISCLOSURE: The following authors have nothing to disclose: Stephen Eikermann, Timothy Murphy, Antonio Guzman, David Vanderheiden, Chinthaka Bulathsinghala, Salim Surani

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