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Pneumocafé project: an inquiry on current COPD diagnosis and management among General Practitioners in Italy through a novel tool for professional education.

Sanguinetti CM, De Benedetto F, Donner CF, Nardini S, Visconti A - Multidiscip Respir Med (2014)

Bottom Line: The results of the analysis of these questionnaires are here presented. 1, 964 questionnaires were returned from 49 RSs. 1,864 questionnaires out of those received (94.91% of the total) resulted properly compiled and form the object of the present analysis.Control of patient's adherence to therapy is mainly carried out by GPs checking the number of drugs annually prescribed or asking the patient during a control visit.The results obtained with this project confirm the validity of this informal approach to professional education.

View Article: PubMed Central - HTML - PubMed

Affiliation: Consultant in Respiratory Medicine and CEO of FISAR, Rome, Italy.

ABSTRACT

Background: Symptoms of COPD are frequently disregarded by patients and also by general practitioners (GPs) in early stages of the disease, that consequently is diagnosed when already at an advanced grade of severity. Underdiagnosis and undertreatment of COPD and scarce use of spirometry are widely recurrent, while a better knowledge of the disease and a wider use of spirometry would be critical to diagnose more patients still neglected, do it at an earlier stage and properly treat established COPD. The aim of Pneumocafè project is to improve, through an innovative approach, the diagnosis and management of COPD at primary care level increasing the awareness of issues pertaining to early diagnosis, adequate prevention and correct treatment of the disease.

Methods: Pneumocafè is based on informal meetings between GPs of various geographical zones of Italy and their reference respiratory specialist (RS), aimed at discussing the current practice in comparison to suggestions of official guidelines, analyzing the actual problems in diagnosing and managing COPD patients and sharing the possible solution at the community level. In these meetings RSs faced many issues including patho-physiological mechanisms of bronchial obstruction, significance of clinical symptoms, patients' phenotyping, and clinical approach to diagnosis and long-term treatment, also reinforcing the importance of a timely diagnosis, proper long term treatment and the compliance to treatment. At the end of each meeting GPs had to fill in a questionnaire arranged by the scientific board of the Project that included 18 multiple-choice questions concerning their approach to COPD management. The results of the analysis of these questionnaires are here presented.

Results: 1, 964 questionnaires were returned from 49 RSs. 1,864 questionnaires out of those received (94.91% of the total) resulted properly compiled and form the object of the present analysis. The 49 RSs, 37 males and 12 females, were distributed all over the Italian country and practiced their profession both in public and private hospitals and in territorial sanitary facilities. GPs were 1,330 males (71.35%) and 534 females (28.64%), mean age 56,29 years (range 27-70 yrs). Mean duration of general practice was 25.56 years (range: 0,5-40 yrs) with a mean of 1,302.43 patients assisted by each GP and 2,427,741 patients assisted in all. The majority of GPs affirmed that in their patients COPD has a mean-to-great prevalence and a mean/high impact on their practice, preceded only by diabetes and heart failure. Three-quarters of GPs refer to COPD guidelines and most of them believe that a screening on their assisted patients at risk would enhance early diagnosis of COPD. Tobacco smoking is the main recognized cause of COPD but the actions carried out by GPs to help a patient to give up smoking result still insufficient. The majority of GPs recognize spirometry as necessary to early COPD diagnosis, but the main obstacle pointed out to its wider use was the too long time for the spirometry to be performed. GPs' main reason for prescribing a bronchodilator is dyspnea and bronchodilators preferably prescribed are LABA and LAMA. Control of patient's adherence to therapy is mainly carried out by GPs checking the number of drugs annually prescribed or asking the patient during a control visit. Finally, about how many COPD patients GPs believe are in their group of assisted patients, a mean range of 25-40 patients was reported, that is consistently below the forecast based on epidemiological data and number of patients assisted by each GP.

Conclusions: The results obtained with this project confirm the validity of this informal approach to professional education. Furthermore, this inquiry provided important insights about the general management of COPD and the process of integration between RS and GPs activities on this disease condition in the long run.

No MeSH data available.


Related in: MedlinePlus

Bronchodilator drugs preferentially prescribed by GPs to a mild-to-moderate symptomatic COPD patient at first diagnosis.
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Figure 4: Bronchodilator drugs preferentially prescribed by GPs to a mild-to-moderate symptomatic COPD patient at first diagnosis.

Mentions: Concerning the therapeutic approach to COPD, GPs’ main reason for prescribing a bronchodilator is dyspnea, followed by cough and sputum production, whereas the least importance is attributed to the patient’s capacity of performing daily activities (Table 11).Bronchodilator drug GPs preferentially prescribe to a symptomatic patient with mild-to-moderate COPD at first diagnosis is a long-acting beta-2 agonist taken on a regular basis, and the second preferred choice is a long-acting antimuscarinic drug (i.e LABA or LAMA are prescribed by more than 60% of GPs) (Figure 4).GPs were also asked whether and how they verify the adherence of their patients to the arranged therapeutic plan and the correct uptake of drugs. The majority of GPs (47.41%) answered they ask patients information about their adherence to therapy during a control visit, whereas another consistent percentage of GPs affirm they check in their records the number of drugs prescribed annually and only 10.41% of them let patients verify on their own the adherence to therapy (Figure 5).


Pneumocafé project: an inquiry on current COPD diagnosis and management among General Practitioners in Italy through a novel tool for professional education.

Sanguinetti CM, De Benedetto F, Donner CF, Nardini S, Visconti A - Multidiscip Respir Med (2014)

Bronchodilator drugs preferentially prescribed by GPs to a mild-to-moderate symptomatic COPD patient at first diagnosis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4061438&req=5

Figure 4: Bronchodilator drugs preferentially prescribed by GPs to a mild-to-moderate symptomatic COPD patient at first diagnosis.
Mentions: Concerning the therapeutic approach to COPD, GPs’ main reason for prescribing a bronchodilator is dyspnea, followed by cough and sputum production, whereas the least importance is attributed to the patient’s capacity of performing daily activities (Table 11).Bronchodilator drug GPs preferentially prescribe to a symptomatic patient with mild-to-moderate COPD at first diagnosis is a long-acting beta-2 agonist taken on a regular basis, and the second preferred choice is a long-acting antimuscarinic drug (i.e LABA or LAMA are prescribed by more than 60% of GPs) (Figure 4).GPs were also asked whether and how they verify the adherence of their patients to the arranged therapeutic plan and the correct uptake of drugs. The majority of GPs (47.41%) answered they ask patients information about their adherence to therapy during a control visit, whereas another consistent percentage of GPs affirm they check in their records the number of drugs prescribed annually and only 10.41% of them let patients verify on their own the adherence to therapy (Figure 5).

Bottom Line: The results of the analysis of these questionnaires are here presented. 1, 964 questionnaires were returned from 49 RSs. 1,864 questionnaires out of those received (94.91% of the total) resulted properly compiled and form the object of the present analysis.Control of patient's adherence to therapy is mainly carried out by GPs checking the number of drugs annually prescribed or asking the patient during a control visit.The results obtained with this project confirm the validity of this informal approach to professional education.

View Article: PubMed Central - HTML - PubMed

Affiliation: Consultant in Respiratory Medicine and CEO of FISAR, Rome, Italy.

ABSTRACT

Background: Symptoms of COPD are frequently disregarded by patients and also by general practitioners (GPs) in early stages of the disease, that consequently is diagnosed when already at an advanced grade of severity. Underdiagnosis and undertreatment of COPD and scarce use of spirometry are widely recurrent, while a better knowledge of the disease and a wider use of spirometry would be critical to diagnose more patients still neglected, do it at an earlier stage and properly treat established COPD. The aim of Pneumocafè project is to improve, through an innovative approach, the diagnosis and management of COPD at primary care level increasing the awareness of issues pertaining to early diagnosis, adequate prevention and correct treatment of the disease.

Methods: Pneumocafè is based on informal meetings between GPs of various geographical zones of Italy and their reference respiratory specialist (RS), aimed at discussing the current practice in comparison to suggestions of official guidelines, analyzing the actual problems in diagnosing and managing COPD patients and sharing the possible solution at the community level. In these meetings RSs faced many issues including patho-physiological mechanisms of bronchial obstruction, significance of clinical symptoms, patients' phenotyping, and clinical approach to diagnosis and long-term treatment, also reinforcing the importance of a timely diagnosis, proper long term treatment and the compliance to treatment. At the end of each meeting GPs had to fill in a questionnaire arranged by the scientific board of the Project that included 18 multiple-choice questions concerning their approach to COPD management. The results of the analysis of these questionnaires are here presented.

Results: 1, 964 questionnaires were returned from 49 RSs. 1,864 questionnaires out of those received (94.91% of the total) resulted properly compiled and form the object of the present analysis. The 49 RSs, 37 males and 12 females, were distributed all over the Italian country and practiced their profession both in public and private hospitals and in territorial sanitary facilities. GPs were 1,330 males (71.35%) and 534 females (28.64%), mean age 56,29 years (range 27-70 yrs). Mean duration of general practice was 25.56 years (range: 0,5-40 yrs) with a mean of 1,302.43 patients assisted by each GP and 2,427,741 patients assisted in all. The majority of GPs affirmed that in their patients COPD has a mean-to-great prevalence and a mean/high impact on their practice, preceded only by diabetes and heart failure. Three-quarters of GPs refer to COPD guidelines and most of them believe that a screening on their assisted patients at risk would enhance early diagnosis of COPD. Tobacco smoking is the main recognized cause of COPD but the actions carried out by GPs to help a patient to give up smoking result still insufficient. The majority of GPs recognize spirometry as necessary to early COPD diagnosis, but the main obstacle pointed out to its wider use was the too long time for the spirometry to be performed. GPs' main reason for prescribing a bronchodilator is dyspnea and bronchodilators preferably prescribed are LABA and LAMA. Control of patient's adherence to therapy is mainly carried out by GPs checking the number of drugs annually prescribed or asking the patient during a control visit. Finally, about how many COPD patients GPs believe are in their group of assisted patients, a mean range of 25-40 patients was reported, that is consistently below the forecast based on epidemiological data and number of patients assisted by each GP.

Conclusions: The results obtained with this project confirm the validity of this informal approach to professional education. Furthermore, this inquiry provided important insights about the general management of COPD and the process of integration between RS and GPs activities on this disease condition in the long run.

No MeSH data available.


Related in: MedlinePlus