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Management of COPD in general practice in Denmark--participating in an educational program substantially improves adherence to guidelines.

Ulrik CS, Hansen EF, Jensen MS, Rasmussen FV, Dollerup J, Hansen G, Andersen KK, KVASIMODO II study gro - Int J Chron Obstruct Pulmon Dis (2010)

Bottom Line: Two cross-sectional surveys were performed precisely one year apart before and after an educational program for the participating GPs.The proportion of patients having FEV(1) registered in the GPs files increased from 45% to 69% (P < 0.001); and, furthermore, FEV(1) % of predicted was recorded in 30% and 56%, respectively, of the cases (P < 0.001).In line with this, significant improvements were also observed for registration of smoking status (69% to 85%), BMI (8% to 40%), severity of dyspnea (Medical Research Council) (7% to 38%), and FEV(1)/FVC ratio (28% to 58%) (P < 0.001).

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology and Respiratory Medicine, Hvidovre Hospital, Copenhagen, Denmark. csulrik@dadlnet.dk

ABSTRACT

Background and aim: The general practitioner (GP) is the first contact with the health care system for most patients with COPD in Denmark. We studied, if participating in an educational program could improve adherence to guidelines, not least for diagnosis, staging, and treatment of the disease.

Design and setting: Two cross-sectional surveys were performed precisely one year apart before and after an educational program for the participating GPs. A total of 124 GPs completed the study; 1716 and 1342 patients with GP-diagnosed COPD and no concomitant asthma, respectively, were included in the two surveys.

Results: The proportion of patients having FEV(1) registered in the GPs files increased from 45% to 69% (P < 0.001); and, furthermore, FEV(1) % of predicted was recorded in 30% and 56%, respectively, of the cases (P < 0.001). In line with this, significant improvements were also observed for registration of smoking status (69% to 85%), BMI (8% to 40%), severity of dyspnea (Medical Research Council) (7% to 38%), and FEV(1)/FVC ratio (28% to 58%) (P < 0.001). Concerning the management options, improvements were also observed with regard to antismoking counseling, inhalator technique, physical activity, and referral for rehabilitation; use of inhaled corticosteroids in patients with mild COPD (FEV(1) > 80%pred) declined from 76% to 45%.

Conclusion: Diagnosis and management of COPD in general practice in Denmark is not according to guidelines, but substantial improvements can be achieved by focused education of GPs and their staff.

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Related in: MedlinePlus

Level of FEV1 %pred versus clinical staging of COPD (as judged by the individual patient’s GP based on symptom severity) in the first and the second survey.
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f1-copd-5-073: Level of FEV1 %pred versus clinical staging of COPD (as judged by the individual patient’s GP based on symptom severity) in the first and the second survey.

Mentions: Table 2 shows the results of both audit surveys, ie, the presence of relevant information in the GPs files on indices related to diagnosing and staging of their patients suffering from COPD. At survey 1, only 45 % of the CRFs included relevant spirometric data (FEV1, FVC, and FEV1/FVC ratio), whereas the corresponding figures were 69 % at the 2. survey (P < 0.001). Furthermore, only 21 % of the included patients in survey 1 fulfilled the diagnostic criteria of an FEV1/FVC ratio < 70%, whereas 48 % of the patients included in survey 2 by definition had airway obstruction (P < 0.001). The FEV1 as a percentage of predicted value (requiring data on FEV1, age, and height) was only available for 30% and 56%, respectively, of the included patients at the two surveys (P < 0.001); and the observed correlation between severity of disease as judged by the GP and FEV1 %pred was not optimal (Figure 1).


Management of COPD in general practice in Denmark--participating in an educational program substantially improves adherence to guidelines.

Ulrik CS, Hansen EF, Jensen MS, Rasmussen FV, Dollerup J, Hansen G, Andersen KK, KVASIMODO II study gro - Int J Chron Obstruct Pulmon Dis (2010)

Level of FEV1 %pred versus clinical staging of COPD (as judged by the individual patient’s GP based on symptom severity) in the first and the second survey.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2865027&req=5

f1-copd-5-073: Level of FEV1 %pred versus clinical staging of COPD (as judged by the individual patient’s GP based on symptom severity) in the first and the second survey.
Mentions: Table 2 shows the results of both audit surveys, ie, the presence of relevant information in the GPs files on indices related to diagnosing and staging of their patients suffering from COPD. At survey 1, only 45 % of the CRFs included relevant spirometric data (FEV1, FVC, and FEV1/FVC ratio), whereas the corresponding figures were 69 % at the 2. survey (P < 0.001). Furthermore, only 21 % of the included patients in survey 1 fulfilled the diagnostic criteria of an FEV1/FVC ratio < 70%, whereas 48 % of the patients included in survey 2 by definition had airway obstruction (P < 0.001). The FEV1 as a percentage of predicted value (requiring data on FEV1, age, and height) was only available for 30% and 56%, respectively, of the included patients at the two surveys (P < 0.001); and the observed correlation between severity of disease as judged by the GP and FEV1 %pred was not optimal (Figure 1).

Bottom Line: Two cross-sectional surveys were performed precisely one year apart before and after an educational program for the participating GPs.The proportion of patients having FEV(1) registered in the GPs files increased from 45% to 69% (P < 0.001); and, furthermore, FEV(1) % of predicted was recorded in 30% and 56%, respectively, of the cases (P < 0.001).In line with this, significant improvements were also observed for registration of smoking status (69% to 85%), BMI (8% to 40%), severity of dyspnea (Medical Research Council) (7% to 38%), and FEV(1)/FVC ratio (28% to 58%) (P < 0.001).

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology and Respiratory Medicine, Hvidovre Hospital, Copenhagen, Denmark. csulrik@dadlnet.dk

ABSTRACT

Background and aim: The general practitioner (GP) is the first contact with the health care system for most patients with COPD in Denmark. We studied, if participating in an educational program could improve adherence to guidelines, not least for diagnosis, staging, and treatment of the disease.

Design and setting: Two cross-sectional surveys were performed precisely one year apart before and after an educational program for the participating GPs. A total of 124 GPs completed the study; 1716 and 1342 patients with GP-diagnosed COPD and no concomitant asthma, respectively, were included in the two surveys.

Results: The proportion of patients having FEV(1) registered in the GPs files increased from 45% to 69% (P < 0.001); and, furthermore, FEV(1) % of predicted was recorded in 30% and 56%, respectively, of the cases (P < 0.001). In line with this, significant improvements were also observed for registration of smoking status (69% to 85%), BMI (8% to 40%), severity of dyspnea (Medical Research Council) (7% to 38%), and FEV(1)/FVC ratio (28% to 58%) (P < 0.001). Concerning the management options, improvements were also observed with regard to antismoking counseling, inhalator technique, physical activity, and referral for rehabilitation; use of inhaled corticosteroids in patients with mild COPD (FEV(1) > 80%pred) declined from 76% to 45%.

Conclusion: Diagnosis and management of COPD in general practice in Denmark is not according to guidelines, but substantial improvements can be achieved by focused education of GPs and their staff.

Show MeSH
Related in: MedlinePlus