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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

Prescribed treatment inhaled corticosteroids according to severity of COPD based on measurement of FEV1 in the first and the second survey.
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f3-copd-5-073: Prescribed treatment inhaled corticosteroids according to severity of COPD based on measurement of FEV1 in the first and the second survey.

Mentions: Improvements in several indices of adherence to guidelines for pharmacological and non-pharmacological management were observed from survey 1 to survey 2 (Table 3), including a significant fall in the proportion of patients with mild COPD treated with inhaled corticosteroids (P < 0.01) (Figure 2), especially in patients with available information in the GPs file on FEV1 %pred (76% and 45%, respectively; P < 0.001) (Figure 3).


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)

Prescribed treatment inhaled corticosteroids according to severity of COPD based on measurement of FEV1 in the first and the second survey.
© Copyright Policy
Related In: Results  -  Collection

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

f3-copd-5-073: Prescribed treatment inhaled corticosteroids according to severity of COPD based on measurement of FEV1 in the first and the second survey.
Mentions: Improvements in several indices of adherence to guidelines for pharmacological and non-pharmacological management were observed from survey 1 to survey 2 (Table 3), including a significant fall in the proportion of patients with mild COPD treated with inhaled corticosteroids (P < 0.01) (Figure 2), especially in patients with available information in the GPs file on FEV1 %pred (76% and 45%, respectively; P < 0.001) (Figure 3).

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