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Calle Rubio M, López-Campos JL, Miravitlles M, Soler Cataluña JJ, Alcázar Navarrete B, Fuentes Ferrer ME, Rodríguez Hermosa JL. Variations in Chronic Obstructive Pulmonary Disease Outpatient Care in Respiratory Clinics: Results From the 2021 EPOCONSUL Audit. Arch Bronconeumol 2023; 59:295-304. [PMID: 36858911 DOI: 10.1016/j.arbres.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/21/2023]
Abstract
INTRODUCTION The aim of our work has been to describe the results of the clinical audit carried out in 2021 and to compare the results with 2015 EPOCONSUL audit. METHODS EPOCONSUL 2021 is a cross-sectional audit that evaluated the outpatient care provided to patients with a diagnosis of chronic obstructive pulmonary disease (COPD) in respiratory clinics in Spain with prospective recruitment between April 15, 2021, and January 31, 2022. RESULTS A total of 45 hospitals participated in the 2021 audit and 4.225 clinical records of patients were evaluated. Clinical phenotype according to the Spanish National Guidelines for COPD care (GesEPOC) was reported in 63.1% of the audited patients, and the COPD type assessment for the Global initiative for chronic Obstructive Lung Disease (GOLD) was present in 38.3%. There was an improved compliance with clinical practice guideline (CPG) recommendations in the 2021 audit with respect to the 2015 audit. There was an increase in the proportion of cases with alfa-1-antitrypsin serum level testing available (audit 1: 18.9%; audit 2: 38.7%, p<0.001) and 6-min walk test carried out (audit 1: 24%; audit 2: 45.2%, p<0.001). However, these significant variations adherence to CPG recommendations were not reached for the clinical evaluation and therapeutic intervention category when adjusting for patient and resource variables. CONCLUSIONS The 2021 EPOCONSUL audit showed increased adherence to recommendations although they seem to be related to the availability of resources for care. These results should be taken into account in order to establish improvements in resources to achieve a better quality of care.
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Affiliation(s)
- Myriam Calle Rubio
- Pulmonology Department, Hospital Clínico San Carlos, Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - José Luis López-Campos
- Respiratory Disease Medical-Surgical Unit, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Marc Miravitlles
- Pulmonology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | | | | | - Manuel E Fuentes Ferrer
- Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Juan Luis Rodríguez Hermosa
- Pulmonology Department, Hospital Clínico San Carlos, Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
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Bhutani M, Price DB, Winders TA, Worth H, Gruffydd-Jones K, Tal-Singer R, Correia-de-Sousa J, Dransfield MT, Peché R, Stolz D, Hurst JR. Quality Standard Position Statements for Health System Policy Changes in Diagnosis and Management of COPD: A Global Perspective. Adv Ther 2022; 39:2302-2322. [PMID: 35482251 PMCID: PMC9047462 DOI: 10.1007/s12325-022-02137-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/17/2022] [Indexed: 11/22/2022]
Abstract
Introduction Despite being a leading cause of death worldwide, chronic obstructive pulmonary disease (COPD) is underdiagnosed and underprioritized within healthcare systems. Existing healthcare policies should be revisited to include COPD prevention and management as a global priority. Here, we propose and describe health system quality standard position statements that should be implemented as a consistent standard of care for patients with COPD. Methods A multidisciplinary group of clinicians with expertise in COPD management together with patient advocates from eight countries participated in a quality standards review meeting convened in April 2021. The principal objective was to achieve consensus on global health system priorities to ensure consistent standards of care for COPD. These quality standard position statements were either evidence-based or reflected the combined views of the panel. Results On the basis of discussions, the experts adopted five quality standard position statements, including the rationale for their inclusion, supporting clinical evidence, and essential criteria for quality metrics. These quality standard position statements emphasize the core elements of COPD care, including (1) diagnosis, (2) adequate patient and caregiver education, (3) access to medical and nonmedical treatments aligned with the latest evidence-based recommendations and appropriate management by a respiratory specialist when required, (4) appropriate management of acute COPD exacerbations, and (5) regular patient and caregiver follow-up for care plan reviews. Conclusions These practical quality standards may be applicable to and implemented at both local and national levels. While universally applicable to the core elements of appropriate COPD care, they can be adapted to consider differences in healthcare resources and priorities, organizational structure, and care delivery capabilities of individual healthcare systems. We encourage the adoption of these global quality standards by policymakers and healthcare practitioners alike to inform national and regional health system policy revisions to improve the quality and consistency of COPD care worldwide. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02137-x.
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Indicadores de calidad asistencial en patología respiratoria en la Comunidad de Madrid. Arch Bronconeumol 2019; 55:441-442. [DOI: 10.1016/j.arbres.2019.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 11/18/2022]
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Quirós S, de la Rosa D, Uranga A, Madero R, Amaro R, Bruguera N, García JA, Gómez C, Iturbe D, Lera R, Luque L, Martínez AJ, Mínguez P, Navarro A, Sánchez G, Suárez-Cuartín G. Screening for latent tuberculosis infection in patients who are candidate for biological therapies in Spain? A multidisciplinary survey. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.arbr.2018.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Quirós S, de la Rosa D, Uranga A, Madero R, Amaro R, Bruguera N, García JA, Gómez C, Iturbe D, Lera R, Luque L, Martínez AJ, Mínguez P, Navarro A, Sánchez G, Suárez-Cuartín G. Screening for Latent Tuberculosis Infection in Patients who are Candidate for Biological Therapies in Spain? A Multidisciplinary Survey. Arch Bronconeumol 2018; 54:510-517. [PMID: 29941293 DOI: 10.1016/j.arbres.2018.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/11/2018] [Accepted: 04/12/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Treatment with biological therapies increases the incidence of tuberculous disease. The introduction of systematic screening for latent tuberculosis infection in patients who are to receive these therapies has reduced this risk. In 2016, the consensus document on the prevention and treatment of tuberculosis in patients who are candidates for biological treatment was published in Spain. The main objective of this study was to evaluate adherence to these guidelines. METHODS Multicenter, descriptive, observational study via an anonymous online survey sent to medical societies involved in biologics. RESULTS We received 747 responses. Most respondents performed screening at the right time in the right patients (93.7%). Only 36.6% of respondents requested the appropriate diagnostic test, while 56.3% correctly recommended chemoprophylaxis. Up to 96% were familiar with the recommended chemoprophylaxis regimens, while only 63.9% initiated them at the right time. The specialist area that participated most and screened most patients for latent tuberculosis infection was rheumatology (54%). In most cases, pulmonologists were involved in an advisory capacity. CONCLUSIONS This study shows poor overall adherence to recommendations, with only 56% of respondents reporting appropriate compliance. The incidence of tuberculous disease in patients who are to receive biological therapies could be reduced further by emphasizing the importance of the right diagnostic test and use of the diagnostic algorithm for latent tuberculosis infection.
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Affiliation(s)
- Sarai Quirós
- Servicio de Neumología, Hospital General Universitario La Paz-Carlos III- Cantoblanco, Madrid, España.
| | | | - Ane Uranga
- Servicio de Neumología, Hospital de Galdakao-Usansolo, Bizkaia, España
| | - Rosario Madero
- Sección de Bioestadística - IdiPAZ, Hospital General Universitario La Paz, Madrid, España
| | - Rosanel Amaro
- Servicio de Neumología, Hospital Clinic, Barcelona, España
| | - Nuria Bruguera
- Servicio de Neumología, Hospital Comarcal Sant Jaume de Calella, Barcelona, España
| | | | - C Gómez
- Servicio de Neumología, Hospital General de la Defensa, Zaragoza, España
| | - David Iturbe
- Servicio de Neumología, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Rubén Lera
- Servicio de Neumología, Hospital Doctor Peset, Valencia, España
| | - Lydia Luque
- Servicio de Neumología, Hospital Moisés Broggi, Barcelona, España
| | - Abel J Martínez
- Servicio de Neumología, Hospital Universitario de Albacete, Albacete, España
| | - Patricia Mínguez
- Servicio de Neumología, Hospital Puerta de Hierro, Madrid, España
| | - Annie Navarro
- Servicio de Neumología, Mutua de Terrassa, Barcelona, España
| | - Gema Sánchez
- Servicio de Neumología, HGU Gregorio Marañón, Madrid, España
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COPD prevalence and hospital admissions in Galicia (Spain). An analysis using the potential of new health information systems. Pulmonology 2018; 24:323-329. [PMID: 29739657 DOI: 10.1016/j.pulmoe.2018.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 03/15/2018] [Accepted: 03/16/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Chronic obstructive pulmonary disease (COPD) is a major public health problem. The aim of this study was to ascertain the prevalence of COPD and whether such prevalence was positively or negatively associated with COPD admissions, using all the data of a regional health care system. MATERIALS AND METHODS We designed a descriptive cross-sectional study which included all subjects aged over 45 years, diagnosed with COPD in primary care in 2013. We also calculated the number of such patients who had a record of hospital admissions due to this disease. COPD prevalence and incidence of admissions were calculated. Poisson regression models were then used to analyse the association between cases with diagnosis of COPD and admissions due to COPD, by sex, adjusting for socio-demographic variables and distance to hospital. Sensitivity subanalyses were performed by reference to the respective municipal rurality indices. RESULTS Median municipal prevalence of COPD was 5.29% in men and 2.19% in women. Among patients with COPD, 28.22% of men and 16.00% of women had at least one hospital admission. The relative risk of admission per unit of the standardised prevalence ratio was 0.37 (95% CI 0.34-0.41) for men and 0.39 (95% CI 0.34-0.45) for women. CONCLUSIONS There is a significant negative association between COPD prevalence and hospital admissions due to this disease. The proportion of admissions is lower in municipalities lying furthest from hospitals. There is considerable municipal variability in terms of COPD prevalence and proportion of admissions. In-depth attention should be given to disease-management training programmes.
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Soler-Cataluña JJ. Guías de práctica clínica o medicina personalizada en la enfermedad pulmonar obstructiva crónica. Arch Bronconeumol 2018; 54:247-248. [DOI: 10.1016/j.arbres.2017.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 08/25/2017] [Accepted: 08/30/2017] [Indexed: 01/09/2023]
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Calle Rubio M, López-Campos JL, Soler-Cataluña JJ, Alcázar Navarrete B, Soriano JB, Rodríguez González-Moro JM, Fuentes Ferrer ME, Rodríguez Hermosa JL. Variability in adherence to clinical practice guidelines and recommendations in COPD outpatients: a multi-level, cross-sectional analysis of the EPOCONSUL study. Respir Res 2017; 18:200. [PMID: 29197415 PMCID: PMC5712134 DOI: 10.1186/s12931-017-0685-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 11/19/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical audits have reported considerable variability in COPD medical care and frequent inconsistencies with recommendations. The objectives of this study were to identify factors associated with a better adherence to clinical practice guidelines and to explore determinants of this variability at the the hospital level. METHODS EPOCONSUL is a Spanish nationwide clinical audit that evaluates the outpatient management of COPD. Multilevel logistic regression with two levels was performed to assess the relationships between individual and disease-related factors, as well as hospital characteristics. RESULTS A total of 4508 clinical records of COPD patients from 59 Spanish hospitals were evaluated. High variability was observed among hospitals in terms of medical care. Some of the patient's characteristics (airflow obstruction, degree of dyspnea, exacerbation risk, presence of comorbidities), the hospital factors (size and respiratory nurses available) and treatment at a specialized COPD outpatient clinic were identified as factors associated with a better adherence to recommendations, although this only explains a small proportion of the total variance. CONCLUSION To be treated at a specialized COPD outpatient clinic and some intrinsic patient characteristics were factors associated with a better adherence to guideline recommendations, although these variables were only explaining part of the high variability observed among hospitals in terms of COPD medical care.
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Affiliation(s)
- Myriam Calle Rubio
- Pulmonary Department, Research Institute of Hospital Clínico San Carlos (IdISSC), Faculty of Medicine, University Complutense of Madrid, C/ Martin Lagos s/n, 28040, Madrid, Spain.
| | - José Luis López-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad of Sevilla, Sevilla, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - Joan B Soriano
- Research Institute of Hospital University La Princesa (IISP), University Autónoma of Madrid, Madrid, Spain
| | | | - Manuel E Fuentes Ferrer
- UGC de Medicina Preventiva, Research Institute of Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Faculty of Medicine, University Complutense of Madrid, Madrid, Spain
| | - Juan Luis Rodríguez Hermosa
- Pulmonary Department, Research Institute of Hospital Clínico San Carlos (IdISSC), Faculty of Medicine, University Complutense of Madrid, C/ Martin Lagos s/n, 28040, Madrid, Spain
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López-Campos JL, Abad Arranz M, Calero-Acuña C, Romero-Valero F, Ayerbe-García R, Hidalgo-Molina A, Aguilar-Pérez-Grovas RI, García-Gil F, Casas-Maldonado F, Caballero-Ballesteros L, Sánchez-Palop M, Pérez-Tejero D, Segado Soriano A, Calvo-Bonachera J, Hernández-Sierra B, Doménech A, Arroyo-Varela M, González-Vargas F, Cruz-Rueda JJ. Seasonal variability in clinical care of COPD outpatients: results from the Andalusian COPD audit. Int J Chron Obstruct Pulmon Dis 2017; 12:785-792. [PMID: 28424549 PMCID: PMC5344429 DOI: 10.2147/copd.s121885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Clinical practice in chronic obstructive pulmonary disease (COPD) can be influenced by weather variability throughout the year. To explore the hypothesis of seasonal variability in clinical practice, the present study analyzes the results of the 2013-2014 Andalusian COPD audit with regard to changes in clinical practice according to the different seasons. METHODS The Andalusian COPD audit was a pilot clinical project conducted from October 2013 to September 2014 in outpatient respiratory clinics of hospitals in Andalusia, Spain (8 provinces with more than 8 million inhabitants) with retrospective data gathering. For the present analysis, astronomical seasons in the Northern Hemisphere were used as reference. Bivariate associations between the different COPD guidelines and the clinical practice changes over the seasons were explored by using binomial multivariate logistic regression analysis with age, sex, Charlson comorbidity index, type of hospital, and COPD severity by forced expiratory volume in 1 second as covariates, and were expressed as odds ratio (OR) with 95% confidence intervals (CIs). RESULTS The Andalusian COPD audit included 621 clinical records from 9 hospitals. After adjusting for covariates, only inhaler device satisfaction evaluation was found to significantly differ according to the seasons with an increase in winter (OR, 3.460; 95% CI, 1.469-8.151), spring (OR, 4.215; 95% CI, 1.814-9.793), and summer (OR, 3.371; 95% CI, 1.391-8.169) compared to that in autumn. The rest of the observed differences were not significant after adjusting for covariates. However, compliance with evaluating inhaler satisfaction was low. CONCLUSION The various aspects of clinical practice for COPD care were found to be quite homogeneous throughout the year for the variables evaluated. Inhaler satisfaction evaluation, however, presented some significant variation during the year. Inhaler device satisfaction should be evaluated during all clinical visits throughout the year for improved COPD management.
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Affiliation(s)
- Jose Luis López-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville.,CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid
| | - Maria Abad Arranz
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville
| | - Carmen Calero-Acuña
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville.,CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid
| | | | | | | | | | | | | | | | | | | | | | | | | | - Adolfo Doménech
- Servicio de Neumología, Hospital Regional Universitario de Málaga, Málaga
| | | | | | - Juan J Cruz-Rueda
- Servicio de Neumología, Hospital Universitario Virgen de las Nieves, Granada, Spain
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Calle Rubio M, Alcázar Navarrete B, Soriano JB, Soler-Cataluña JJ, Rodríguez González-Moro JM, Fuentes Ferrer ME, López-Campos JL. Clinical audit of COPD in outpatient respiratory clinics in Spain: the EPOCONSUL study. Int J Chron Obstruct Pulmon Dis 2017; 12:417-426. [PMID: 28182155 PMCID: PMC5279956 DOI: 10.2147/copd.s124482] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND 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. METHODOLOGY 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. RESULTS 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%. CONCLUSION 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.
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Affiliation(s)
- Myriam Calle Rubio
- Pulmonary Department, Hospital Clínico San Carlos
- Department of Medicine, Faculty of Medicine, University Complutense of Madrid
- Research Institute of Hospital Clínico San Carlos (IdISSC), Madrid
| | | | - Joan B Soriano
- Research Institute of Hospital University La Princesa (IISP), University Autónoma of Madrid
| | | | | | - Manuel E Fuentes Ferrer
- Department of Medicine, Faculty of Medicine, University Complutense of Madrid
- Research Institute of Hospital Clínico San Carlos (IdISSC), Madrid
- UGC of Preventive Medicine and Research Institute of Hospital Clínico San Carlos, Madrid
| | - José Luis López-Campos
- Pulmonary Department, Hospital University Virgen del Rocio, Institute of Biomedicine of Sevilla (IBiS), Sevilla, Spain
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Garrastazu R, García-Rivero JL, Ruiz-Nuñez M, Helguera JM, Arenal S, Bonnardeux C, León C, Miravitlles M, Santibañez M. [Reliability of a chronic obstructive pulmonary disease diagnosis register in Primary Care]. Semergen 2016; 43:364-374. [PMID: 27692678 DOI: 10.1016/j.semerg.2016.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 05/24/2016] [Accepted: 06/02/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION/OBJECTIVE One of main limitations in studies of COPD in health databases could be the low quality of the information. Our first aim was evaluate reliability of the registry of COPD diagnosis register in Primary Care. A description and comparison is also presented of the characteristics of the patients according to the diagnostic confirmation. MATERIAL AND METHODS A cross-sectional study using healthcare databases of Cantabria. A pre-selected sample of 1,457 patients was obtained in which COPD diagnosis was specifically registered. COPD confirmation was classified into confirmed COPD, not confirmed-not rejected COPD, and diagnostic error (over-diagnosis). Descriptive and clinical characteristics, comorbidities, and treatments were collected in each group. RESULTS COPD was confirmed in 766 patients: 52.6% (95%CI: 49.9-55.2). Prevalence of over-diagnosis was 7.2% (95%CI: 5.9-8.6). There were statistically significant gender differences. In the COPD confirmed group age, tobacco consumption and severity according to FEV1 was higher. An average of 1.95 bronchial exacerbations during the last 4years was observed among diagnostic errors. Inhaled corticosteroids were prescribed in 74.9% of COPD confirmed patients, and in 41.9% of over-diagnosed patients. CONCLUSIONS The reliability of the COPD register was deficient, with only 52.6% with a confirmed diagnosis. Stable treatment for COPD was prescribed in all groups, highlighting the use of inhaled corticosteroids.
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Affiliation(s)
- R Garrastazu
- Centro de Salud de Gama, Servicio Cántabro de Salud, Bárcena de Cicero, España.
| | | | - M Ruiz-Nuñez
- Centro de Salud de Liérganes, Servicio Cántabro de Salud, Miera, España
| | - J M Helguera
- Centro de Salud Bajo Asón, Servicio Cántabro de Salud, Ampuero, España
| | - S Arenal
- Centro de Salud de Suances, Servicio Cántabro de Salud, Suances, España
| | - C Bonnardeux
- Centro de Salud Campoo-Los Valles, Servicio Cántabro de Salud, Mataporquera, España
| | - C León
- Centro de Salud de Suances, Servicio Cántabro de Salud, Suances, España
| | - M Miravitlles
- Servicio de Neumología, Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, España
| | - M Santibañez
- Área de Medicina Preventiva y Salud Pública, Universidad de Cantabria-IDIVAL, Santander, España
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López-Campos JL, Abad Arranz M, Calero-Acuña C, Romero-Valero F, Ayerbe-García R, Hidalgo-Molina A, Aguilar-Pérez-Grovas RI, García-Gil F, Casas-Maldonado F, Caballero-Ballesteros L, Sánchez-Palop M, Pérez-Tejero D, Segado A, Calvo-Bonachera J, Hernández-Sierra B, Doménech A, Arroyo-Varela M, González-Vargas F, Cruz-Rueda JJ. Guideline Adherence in Outpatient Clinics for Chronic Obstructive Pulmonary Disease: Results from a Clinical Audit. PLoS One 2016; 11:e0151896. [PMID: 26985822 PMCID: PMC4795772 DOI: 10.1371/journal.pone.0151896] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 03/04/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Previous clinical audits of COPD have provided relevant information about medical intervention in exacerbation admissions. The present study aims to evaluate adherence to current guidelines in COPD through a clinical audit. METHODS This is a pilot clinical audit performed in hospital outpatient respiratory clinics in Andalusia, Spain (eight provinces with more than 8 million inhabitants), including 9 centers (20% of the public centers in the area) between 2013 and 2014. Cases with an established diagnosis of COPD based on risk factors, clinical symptoms, and a post-bronchodilator FEV1/FVC ratio of less than 0.70 were deemed eligible. The performance of the outpatient clinics was benchmarked against three guidance documents available at the time of the audit. The appropriateness of the performance was categorized as excellent (>80%), good (60-80%), adequate (40-59%), inadequate (20-39%), and highly inadequate (<20%). RESULTS During the audit, 621 clinical records were audited. Adherence to the different guidelines presented a considerable variability among the different participating hospitals, with an excellent or good adherence for symptom recording, MRC or CAT use, smoking status evaluation, spirometry, or bronchodilation therapy. The most outstanding areas for improvement were the use of the BODE index, the monitoring of treatments, the determination of alpha1-antitrypsin, the performance of exercise testing, and vaccination recommendations. CONCLUSIONS The present study reflects the situation of clinical care for COPD patients in specialized secondary care outpatient clinics. Adherence to clinical guidelines shows considerable variability in outpatient clinics managing COPD patients, and some aspects of the clinical care can clearly be improved.
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Affiliation(s)
- Jose L. López-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- * E-mail:
| | - Maria Abad Arranz
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain
| | - Carmen Calero-Acuña
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
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Clinical Audits in Outpatient Clinics for Chronic Obstructive Pulmonary Disease: Methodological Considerations and Workflow. PLoS One 2015; 10:e0141856. [PMID: 26544556 PMCID: PMC4636163 DOI: 10.1371/journal.pone.0141856] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 10/14/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Previous clinical audits for chronic obstructive pulmonary disease (COPD) have provided valuable information on the clinical care delivered to patients admitted to medical wards because of COPD exacerbations. However, clinical audits of COPD in an outpatient setting are scarce and no methodological guidelines are currently available. Based on our previous experience, herein we describe a clinical audit for COPD patients in specialized outpatient clinics with the overall goal of establishing a potential methodological workflow. METHODS A pilot clinical audit of COPD patients referred to respiratory outpatient clinics in the region of Andalusia, Spain (over 8 million inhabitants), was performed. The audit took place between October 2013 and September 2014, and 10 centers (20% of all public hospitals) were invited to participate. Cases with an established diagnosis of COPD based on risk factors, clinical symptoms, and a post-bronchodilator FEV1/FVC ratio of less than 0.70 were deemed eligible. The usefulness of formally scheduled regular follow-up visits was assessed. Two different databases (resources and clinical database) were constructed. Assessments were planned over a year divided by 4 three-month periods, with the goal of determining seasonal-related changes. Exacerbations and survival served as the main endpoints. CONCLUSIONS This paper describes a methodological framework for conducting a clinical audit of COPD patients in an outpatient setting. Results from such audits can guide health information systems development and implementation in real-world settings.
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Results from an audit feedback strategy for chronic obstructive pulmonary disease in-hospital care: a joint analysis from the AUDIPOC and European COPD audit studies. PLoS One 2014; 9:e110394. [PMID: 25333953 PMCID: PMC4198296 DOI: 10.1371/journal.pone.0110394] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 08/21/2014] [Indexed: 11/23/2022] Open
Abstract
Background Clinical audits have emerged as a potential tool to summarize the clinical performance of healthcare over a specified period of time. However, the effectiveness of audit and feedback has shown inconsistent results and the impact of audit and feedback on clinical performance has not been evaluated for COPD exacerbations. In the present study, we analyzed the results of two consecutive nationwide clinical audits performed in Spain to evaluate both the in-hospital clinical care provided and the feedback strategy. Methods The present study is an analysis of two clinical audits performed in Spain that evaluated the clinical care provided to COPD patients who were admitted to the hospital for a COPD exacerbation. The first audit was performed from November–December 2008. The feedback strategy consisted of personalized reports for each participant center, the presentation and discussion of the results at regional, national and international meetings and the creation of health-care quality standards for COPD. The second audit was part of a European study during January and February 2011. The impact of the feedback strategy was evaluated in term of clinical care provided and in-hospital survival. Results A total of 94 centers participated in the two audits, recruiting 8,143 admissions (audit 1∶3,493 and audit 2∶4,650). The initially provided clinical care was reasonably acceptable even though there was considerable variability. Several diagnostic and therapeutic procedures improved in the second audit. Although the differences were significant, the degree of improvement was small to moderate. We found no impact on in-hospital mortality. Conclusions The present study describes COPD hospital care in Spanish hospitals and evaluates the impact of peer-benchmarked, individually written and group-oral feedback strategy on the clinical outcomes for treating COPD exacerbations. It describes small to moderate improvements in the clinical care provided to COPD patients with no impact on in-hospital mortality.
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Zysman M, Patout M, Miravitlles M, van der Molen T, Lokke A, Hausen T, Didier A, Cuvelier A, Roche N. La BPCO et la perception du nouveau document GOLD en Europe. Workshop de la Société de pneumologie de langue française (SPLF). Rev Mal Respir 2014; 31:499-510. [DOI: 10.1016/j.rmr.2014.02.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 02/13/2014] [Indexed: 11/16/2022]
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Lores L. [Application of clinical practice guidelines in chronic obstructive pulmonary disease]. REVISTA DE CALIDAD ASISTENCIAL : ORGANO DE LA SOCIEDAD ESPANOLA DE CALIDAD ASISTENCIAL 2012; 27:303-304. [PMID: 23164238 DOI: 10.1016/j.cali.2012.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 10/22/2012] [Indexed: 06/01/2023]
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Güell MR, Cejudo P, Rodríguez-Trigo G, Gàldiz JB, Casolive V, Regueiro M, Soler-Cataluña JJ. Standards for Quality Care in Respiratory Rehabilitation in Patients With Chronic Pulmonary Disease. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.arbr.2012.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Serrano-Mollar A. [Alveolar epithelial cell injury as an etiopathogenic factor in pulmonary fibrosis]. Arch Bronconeumol 2012; 48 Suppl 2:2-6. [PMID: 23116901 PMCID: PMC7131261 DOI: 10.1016/s0300-2896(12)70044-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Idiopathic pulmonary fibrosis (IPF) is characterized by a progressive accumulation of extracellular matrix and an imbalance between profibrotic and antifibrotic mediators. In the last few years, understanding of the mechanisms of the biology of IPF has increased. One of the most significant discoveries is the finding that alveolar epithelial cell injury plays an important role in the pathogenesis of this disease. In this review, we describe some of the mechanisms involved in alveolar cell injury and their contribution to the development of IPF.
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Affiliation(s)
- Anna Serrano-Mollar
- Departamento de Patología Experimental, Institut d'Investigacions Biomèdiques de Barcelona, España.
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Standards for quality care in respiratory rehabilitation in patients with chronic pulmonary disease. Quality Healthcare Committee. Spanish Society of Pneumology and Thoracic Surgery (SEPAR). Arch Bronconeumol 2012; 48:396-404. [PMID: 22835266 DOI: 10.1016/j.arbres.2012.05.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 05/21/2012] [Accepted: 05/27/2012] [Indexed: 11/21/2022]
Abstract
Respiratory rehabilitation (RR) has been shown to be effective with a high level of evidence in terms of improving symptoms, exertion capacity and health-related quality of life (HRQL) in patients with COPD and in some patients with diseases other than COPD. According to international guidelines, RR is basically indicated in all patients with chronic respiratory symptoms, and the type of program offered depends on the symptoms themselves. As requested by the Spanish Society of Pneumology and Thoracic Surgery (SEPAR), we have created this document with the aim to unify the criteria for quality care in RR. The document is organized into sections: indications for RR, evaluation of candidates, program components, characteristics of RR programs and the role of the administration in the implementation of RR. In each section, we have distinguished 5 large disease groups: COPD, chronic respiratory diseases other than COPD with limiting dyspnea, hypersecretory diseases, neuromuscular diseases with respiratory symptoms and patients who are candidates for thoracic surgery for lung resection.
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Díaz-Grávalos GJ, Palmeiro-Fernández G, Valiño-López MD, Robles-Castiñeiras A, Fernández-Silva MJ, Reinoso-Hermida S, Casado-Górriz I. [The adequacy of the diagnostic in chronic obstructive pulmonary disease]. ACTA ACUST UNITED AC 2012; 27:305-10. [PMID: 22284432 DOI: 10.1016/j.cali.2011.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 07/19/2011] [Accepted: 12/14/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess the adequacy to the clinical guides (GOLD/SEPAR) for the diagnosis of the patients classified as COPD. MATERIAL AND METHODS We selected all COPD cases in the registry of chronic patients of 28 general practitioners from 9 Health Centres in the province of Ourense (Spain). A total of 382 cases were included. Diagnostic accuracy was determined according to the results of spirometry. We identify factors associated with correct diagnosis by logistic regression which included age, gender, residence (rural/urban), smoking, severity, level of follow up and time since diagnosis. RESULTS Of the total number included, 297 were male (77.7%) and 172 patients (45.0%) came from rural areas. The average age was 77.0 (SD=±11.0) years, with a mean age at diagnosis of 64.9 (±12.0) years and the time from diagnosis was 11.5 (±8.0) years. Less than half (49.1%) patients had been smokers, and 13.1% still smoked. Twenty-six cases (6.8%) were diagnosed in Primary Care. The FEV(1)/FVC ratio was recorded in 174 (45.5%) patients, with less than 0.7 in 138 cases (36.1%), which were considered as correctly diagnosed. In these patients the FEV(1) had been recorded in 125 cases (90.6%). A correct diagnosis was associated with severe or very severe disease (OR 5.2; 95% CI; 1.5-17.4), urban areas (OR 6.1; 95% CI, 1.7-21.2), and younger than 60 years (OR 3.7; 95% CI, 1.3-11.2). CONCLUSION The number of spirometry results recorded in the Primary Care medical records of patients diagnosed with COPD was found to be low, and with little adaptation to the accepted diagnostic criteria in the guidelines that are used routinely.
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Documento de consenso sobre enfermedad pulmonar obstructiva crónica en Andalucía-2010. Semergen 2011. [DOI: 10.1016/j.semerg.2011.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Grupo de trabajo de GESEPOC. Hacia un nuevo enfoque en el tratamiento de la EPOC. La Guía Española de la EPOC (GESEPOC). Semergen 2011. [DOI: 10.1016/j.semerg.2011.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Llauger Roselló MA, Pou MA, Domínguez L, Freixas M, Valverde P, Valero C. [Treating COPD in chronic patients in a primary-care setting]. Arch Bronconeumol 2011; 47:561-70. [PMID: 22036593 DOI: 10.1016/j.arbres.2011.10.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 10/05/2011] [Indexed: 10/15/2022]
Abstract
The aging of the populations in Western countries entails an increase in chronic diseases, which becomes evident with the triad of age, comorbidities and polymedication. chronic obstructive pulmonary disease represents one of the most important causes of morbidity and mortality, with a prevalence in Spain of 10.2% in the population aged 40 to 80. In recent years, it has come to be defined not only as an obstructive pulmonary disease, but also as a systemic disease. Some aspects stand out in its management: smoking, the main risk factor, even though avoidable, is an important health problem; very important levels of underdiagnosis and little diagnostic accuracy, with inadequate use of spirometry; chronic patient profile; exacerbations that affect survival and cause repeated hospitalizations; mobilization of numerous health-care resources; need to propose integral care (health-care education, rehabilitation, promotion of self-care and patient involvement in decision-making).
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Coordinación de la asistencia entre un hospital comarcal y su centro de referencia: evaluación de dos modelos de atención neumológica. Arch Bronconeumol 2011; 47:290-5. [DOI: 10.1016/j.arbres.2011.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 02/14/2011] [Accepted: 02/15/2011] [Indexed: 11/22/2022]
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Burgos F. La espirometría forzada de calidad en Atención Primaria, impacto en el tratamiento de la EPOC. Arch Bronconeumol 2011; 47:224-5. [DOI: 10.1016/j.arbres.2011.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 03/02/2011] [Indexed: 11/25/2022]
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Pozo-Rodríguez F, Álvarez CJ, Castro-Acosta A, Moreno CM, Capelastegui A, Esteban C, Carcereny CH, López-Campos JL, Izquierdo Alonso JL, Quílez AL, Agustí A. Clinical Audit of Patients Admitted to Hospital in Spain due to Exacerbation of COPD (AUDIPOC Study): Method and Organisation. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/s1579-2129(10)70084-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Pozo-Rodríguez F, Alvarez CJ, Castro-Acosta A, Melero Moreno C, Capelastegui A, Esteban C, Hernández Carcereny C, López-Campos JL, Izquierdo Alonso JL, López Quílez A, Agustí A. [Clinical audit of patients admitted to hospital in Spain due to exacerbation of COPD (AUDIPOC study): method and organisation]. Arch Bronconeumol 2010; 46:349-57. [PMID: 20554103 DOI: 10.1016/j.arbres.2010.04.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 04/15/2010] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is little information regarding the clinical management of hospital inpatients diagnosed with exacerbation of Chronic Obstructive Pulmonary Disease (COPD). AUDIPOC is a clinical audit dealing with the clinical management of COPD in Spain. OBJECTIVES To examine the adequacy and validity of the instruments used to measure the variables proposed by AUDIPOC Spain (Preliminary Study) and to verify the viability of AUDIPOC in a complex environment with hospitals of different sizes, resources, and organizational layout (Pilot Study). MATERIALS AND METHODS The Preliminary Study took place in 4 hospitals and studied 213 cases. The Pilot Study took place in 30 hospitals of 6 Autonomous Communities (i.e. Regions) and studied 1203 cases. RESULTS The results of both studies contributed to the improvement of the design, methods and organization of the AUDIPOC work. Some of the improvements include better training of those responsible at a hospital level, a new classification of hospitals, the incorporation of new variables and the creation of a Bureau for the Coordination and Management of the Project. CONCLUSIONS The AUDIPOC study is viable. It aims to recruit 10000 patients across 142 hospitals from all the Regions of Spain.
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Affiliation(s)
- Francisco Pozo-Rodríguez
- Neumología, Hospital 12 de Octubre, Madrid, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), España.
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Martín-Escudero J. Conducta a seguir ante la EPOC desde Medicina Interna. Rev Clin Esp 2010; 210:171-7. [DOI: 10.1016/j.rce.2009.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Accepted: 07/24/2009] [Indexed: 10/19/2022]
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Pellicer Císcar C, Soler Cataluña JJ, Andreu Rodríguez AL, Bueso Fabra J. Calidad del diagnóstico de la enfermedad pulmonar obstructiva crónica en el ámbito hospitalario. Arch Bronconeumol 2010; 46:64-9. [DOI: 10.1016/j.arbres.2009.10.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Revised: 10/08/2009] [Accepted: 10/26/2009] [Indexed: 11/28/2022]
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Císcar CP, Cataluña JJS, Rodríguez ALA, Fabra JB. Diagnosis of COPD in Hospitalised Patients. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/s1579-2129(10)70017-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rubio MC, Hermosa JLR, Nebreda MJG, Walther JLÁS. Enfermedad pulmonar obstructiva crónica en Archivos de Bronconeumología en el año 2009. Arch Bronconeumol 2010; 46 Suppl 1:26-9. [DOI: 10.1016/s0300-2896(10)70007-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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