Journal Article

Clinical audit of COPD in outpatient respiratory clinics in Spain: the EPOCONSUL study

Fuentes Ferrer, Manuel E, Calle Rubio, Myriam, Soler-Cataluña, Juan José, Lopez-Campos, José Luis, Alcázar Navarrete, Bernardino, Soriano, Joan B, Rodríguez González-Moro, José-Miguel

2017

Overview

Chronic obstructive pulmonary disease (COPD) outpatients account for a large burden of usual care by respirologists. EPOCONSUL is the first national clinical audit conducted in Spain on the medical care for COPD patients delivered in outpatient respiratory clinics. We aimed to evaluate the clinical interventions and the degree of adherence to recommendations in outpatients of current COPD clinical practice guidelines. This is an observational study with prospective recruitment (May 2014-May 2015) of patients with a COPD diagnosis as seen in outpatient respiratory clinics. The information collected was historical in nature as for the clinical data of the last and previous consultations, and the information concerning hospital resources was concurrent. A total of 17,893 clinical records of COPD patients in outpatient respiratory clinics from 59 Spanish hospitals were evaluated. Of the 5,726 patients selected, 4,508 (78.7%) were eligible. Overall, 12.1% of COPD patients did not fulfill a diagnostic spirometry criteria. Considerable variability existed in the available resources and work organization of the hospitals, although the majority were university hospitals with respiratory inpatient units. There was insufficient implementation of clinical guidelines in preventive and educational matters. In contrast, quantitative evaluation of dyspnea grade (81.9%) and exacerbation history (70.9%) were more frequently performed. Only 12.4% had COPD severity calculated according to the Body mass index, airflow Obstruction, Dyspnoea and Exercise capacity (BODE) index. Phenotype characteristics according to Spanish National Guideline for COPD were determined in 46.3% of the audited patients, and the risk evaluation according to Global initiative for chronic Obstructive Lung Disease was estimated only in 21.9%. The EPOCONSUL study reports the current situation of medical care for COPD patients in outpatient clinics in Spain, revealing its variability, strengths, and weaknesses. This information has to be accounted for by health managers to define corrective strategies and maximize good clinical practice.

• Publisher: Dove Medical Press Limited,Dove Medical Press Ltd,Dove Press,Dove Medical Press
• Subject: adherence / Aged / Audits / Care and treatment / Chronic illnesses / Chronic obstructive lung disease / Chronic obstructive pulmonary disease / clinical audit / clinical guidelines / Clinical medicine / Clinics / Confidentiality / Cross-Sectional Studies / Delivery of Health Care - standards / Development and progression / Epidemiology / Ethics / Evaluation / Exercise Tolerance / Female / Guideline Adherence / Health care / Hospitals / Humans / Lung - physiopathology / Male / Medical Audit / medical care / Medical care quality / Middle Aged / Original Research / Outpatient Clinics, Hospital - standards / Patients / Performance evaluation / Population / Practice guidelines (Medicine) / Practice Guidelines as Topic / Practice Patterns, Physicians' - standards / Process Assessment, Health Care - standards / Prospective Studies / Pulmonary Disease, Chronic Obstructive - diagnosis / Pulmonary Disease, Chronic Obstructive - physiopathology / Pulmonary Disease, Chronic Obstructive - therapy / Pulmonary Medicine / Pulmonologists - standards / Questionnaires / Referral and Consultation / Severity of Illness Index / Spain / Thoracic surgery / Treatment Outcome / Values / Variables