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Álvarez-Dobaño JM, Rodríguez-García C, Atienza G, Toubes ME, Rodríguez-Núñez N, Zamarrón C, Novo-Platas JÁ, Soto-Feijóo R, Landín E, Carreiras-Cuiña M, Martínez-Martínez HJ, Carbajales MC, Otero B, Valdés L. Analysis of the quality of e-Consultations in chronic obstructive pulmonary disease. Respir Med 2024; 222:107514. [PMID: 38171405 DOI: 10.1016/j.rmed.2023.107514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/22/2023] [Accepted: 12/25/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION The quality of e-Consultations in the COPD is unknown. The objectives of this study were (i) to evaluate the quality of referrals; (ii) to define the characteristics of patients referred from Primary Care (PC) to the Unit of Pulmonology; and (iii) to describe differences between accepted and rejected patients. METHODS A retrospective, observational study of e-Consultations requested by PC for suspected COPD throughout 2022. To quantify the quality of the e-Consultations, an arbitrary scale of 12 variables (score 0-10) was created. RESULTS In total, 384 e-Consultations were reviewed, of which 167 (43.5 %) resulted in a face-to-face visit, and 217 (56.5 %) were rejected. No differences were observed between the two types of patients, except for confirmations of diagnostic suspicion of COPD [significantly higher in accepted patients (p = 0.042)]; physical examination data of rejected patients (more data provided; p = 0.015); and lung function (significantly better in rejected patients). The mean quality of referrals was acceptable (5.6 ± 2.1 score): 121 (31.3 %) had insufficient quality; 118 (30.5 %) acceptable; 75 (19.4 %) good, and 30 (7.8 %) excellent. Quality was low in half of the variables analyzed (6/12); acceptable in 3, and good in another 3. The capacity of resolution of referrals was good (one e-Consultation) in 199 requests (66.1 %); deficient (two e-Consultations) in 72 (23.9 %), and poor (≥3 e-Consultations) in 30 (10 %). Overdiagnosis was 40.2 % (86/214 e-Consultations). The risk could be classified in 247 patients (64.3 %; 135 low-risk; 90 high-risk). CONCLUSIONS When adequate information is provided, e-Consultations help identify different levels of severity. However, the quality and capacity of resolution of referrals were suboptimal, with a high percentage of overdiagnoses.
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Affiliation(s)
- José M Álvarez-Dobaño
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain; Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Spain.
| | - Carlota Rodríguez-García
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain; Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Spain.
| | - Gerardo Atienza
- Unidad de Calidad y Seguridad Del Paciente, Subdirección de Calidad, Gerencia Área Sanitaria de Santiago de Compostela y Barbanza, Spain.
| | - María E Toubes
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain.
| | - Nuria Rodríguez-Núñez
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain.
| | - Carlos Zamarrón
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain.
| | - José Ángel Novo-Platas
- Servicio de Control y Gestión, Gerencia Área Sanitaria de Santiago de Compostela y Barbanza, Spain.
| | - Roi Soto-Feijóo
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain.
| | - Elisa Landín
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain.
| | - María Carreiras-Cuiña
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain.
| | | | | | | | - Luis Valdés
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain; Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Santiago de Compostela, Spain.
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Need for Epidemiological Studies on Chronic Obstructive Pulmonary Disease in Rural Spain. Arch Bronconeumol 2021; 57:614-615. [PMID: 35698946 DOI: 10.1016/j.arbr.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 02/24/2021] [Indexed: 11/23/2022]
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Golpe R, Dacal-Rivas D, Blanco-Cid N, Castro-Añón O. Need for Epidemiological Studies on Chronic Obstructive Pulmonary Disease in Rural Spain. Arch Bronconeumol 2021; 57:S0300-2896(21)00075-2. [PMID: 33775451 DOI: 10.1016/j.arbres.2021.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Rafael Golpe
- Servicio de Neumología, Hospital Universitario Lucus Augusti, Lugo, Spain; Grupo C039 Biodiscovery HULA-USC, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
| | - David Dacal-Rivas
- Servicio de Neumología, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Nagore Blanco-Cid
- Servicio de Neumología, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Olalla Castro-Añón
- Servicio de Neumología, Hospital Universitario Lucus Augusti, Lugo, Spain
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Corriveau S, Pond GR, Tang GH, Goffin JR. A population-based analysis of spirometry use and the prevalence of chronic obstructive pulmonary disease in lung cancer. BMC Cancer 2021; 21:14. [PMID: 33402114 PMCID: PMC7786933 DOI: 10.1186/s12885-020-07719-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 12/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) and lung cancer are associated diseases. COPD is underdiagnosed and thus undertreated, but there is limited data on COPD diagnosis in the setting of lung cancer. We assessed the diagnosis of COPD with lung cancer in a large public healthcare system. METHODS Anonymous administrative data was acquired from ICES, which links demographics, hospital records, physician billing, and cancer registry data in Ontario, Canada. Individuals age 35 or older with COPD were identified through a validated, ICES-derived cohort and spirometry use was derived from physician billings. Statistical comparisons were made using Wilcoxon rank sum, Cochran-Armitage, and chi-square tests. RESULTS From 2002 to 2014, 756,786 individuals were diagnosed with COPD, with a 2014 prevalence of 9.3%. Of these, 51.9% never underwent spirometry. During the same period, 105,304 individuals were diagnosed with lung cancer, among whom COPD was previously diagnosed in 34.9%. Having COPD prior to lung cancer was associated with lower income, a rural dwelling, a lower Charlson morbidity score, and less frequent stage IV disease (48 vs 54%, p < 0.001). Spirometry was more commonly undertaken in early stage disease (90.6% in stage I-II vs. 54.4% in stage III-IV). CONCLUSION Over a third of individuals with lung cancer had a prior diagnosis of COPD. Among individuals with advanced lung cancer, greater use of spirometry and diagnosis of COPD may help to mitigate respiratory symptoms.
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Affiliation(s)
- Sophie Corriveau
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
| | - Gregory R Pond
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Grace H Tang
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - John R Goffin
- Division of Medical Oncology, Department of Oncology, McMaster University, Hamilton, Ontario, Canada
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Goffin JR, Pond GR, Puksa S, Tremblay A, Johnston M, Goss G, Nicholas G, Martel S, Bhatia R, Liu G, Schmidt H, Atkar-Khattra S, McWilliams A, Tsao MS, Tammemagi MC, Lam S. Chronic obstructive pulmonary disease prevalence and prediction in a high-risk lung cancer screening population. BMC Pulm Med 2020; 20:300. [PMID: 33198781 PMCID: PMC7670711 DOI: 10.1186/s12890-020-01344-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/09/2020] [Indexed: 12/01/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is an underdiagnosed condition sharing risk factors with lung cancer. Lung cancer screening may provide an opportunity to improve COPD diagnosis. Using Pan-Canadian Early Detection of Lung Cancer (PanCan) study data, the present study sought to determine the following: 1) What is the prevalence of COPD in a lung cancer screening population? 2) Can a model based on clinical and screening low-dose CT scan data predict the likelihood of COPD? Methods The single arm PanCan study recruited current or former smokers age 50–75 who had a calculated risk of lung cancer of at least 2% over 6 years. A baseline health questionnaire, spirometry, and low-dose CT scan were performed. CT scans were assessed by a radiologist for extent and distribution of emphysema. With spirometry as the gold standard, logistic regression was used to assess factors associated with COPD. Results Among 2514 recruited subjects, 1136 (45.2%) met spirometry criteria for COPD, including 833 of 1987 (41.9%) of those with no prior diagnosis, 53.8% of whom had moderate or worse disease. In a multivariate model, age, current smoking status, number of pack-years, presence of dyspnea, wheeze, participation in a high-risk occupation, and emphysema extent on LDCT were all statistically associated with COPD, while the overall model had poor discrimination (c-statistic = 0.627 (95% CI of 0.607 to 0.650). The lowest and the highest risk decile in the model predicted COPD risk of 27.4 and 65.3%. Conclusions COPD had a high prevalence in a lung cancer screening population. While a risk model had poor discrimination, all deciles of risk had a high prevalence of COPD, and spirometry could be considered as an additional test in lung cancer screening programs. Trial registration (Clinical Trial Registration: ClinicalTrials.gov, number NCT00751660, registered September 12, 2008) Supplementary Information The online version contains supplementary material available at 10.1186/s12890-020-01344-y.
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Affiliation(s)
- John R Goffin
- Department of Oncology, McMaster University, Juravinski Cancer Centre, 699 Concession St., Hamilton, ON, L8V 5C2, Canada.
| | - Gregory R Pond
- Department of Oncology, McMaster University, Juravinski Cancer Centre, 699 Concession St., Hamilton, ON, L8V 5C2, Canada
| | - Serge Puksa
- Department of Oncology, McMaster University, Juravinski Cancer Centre, 699 Concession St., Hamilton, ON, L8V 5C2, Canada
| | - Alain Tremblay
- University of Calgary, 3300 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Michael Johnston
- Dalhousie University, 5850 College St, PO Box 15000, Halifax, NS, B3J 3Z3, Canada
| | - Glen Goss
- Ottawa Hospital Research Institute, University of Ottawa, 501 Smyth Rd, Box 511, Ottawa, ON, K1H 8L6, Canada
| | - Garth Nicholas
- Ottawa Hospital Research Institute, University of Ottawa, 501 Smyth Rd, Box 511, Ottawa, ON, K1H 8L6, Canada
| | - Simon Martel
- Centre de recherche de l'Institut universitaire de cardiologie et pneumonolgie de Québec, Université Laval, QC, Québec, G1V 4G5, Canada
| | - Rick Bhatia
- Health Sciences Centre - General Hospital, Memorial University, 300 Prince Phillip Dr, St. John's, NF, A1B 3V6, Canada
| | - Geoffrey Liu
- University Health Network and Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - Heidi Schmidt
- University Health Network and Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - Sukhinder Atkar-Khattra
- British Columbia Cancer Research Centre, University of British Columbia, 675 West 10th Ave, Vancouver, BC, V5Z 1L3, Canada
| | - Annette McWilliams
- Fiona Stanley Hospital, University of Western Australia, 11 Robin Warren Dr, Murdoch, W Australia, 6150, Australia
| | - Ming-Sound Tsao
- University Health Network and Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - Martin C Tammemagi
- Department of Health Sciences, Brock University, Walker Complex South, Rm 306, 500 Glenridge Ave, St. Catharines, ON, L2S 3A1, Canada
| | - Stephen Lam
- British Columbia Cancer Research Centre, University of British Columbia, 675 West 10th Ave, Vancouver, BC, V5Z 1L3, Canada
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Aoki T, Watanuki S. Multimorbidity and patient-reported diagnostic errors in the primary care setting: multicentre cross-sectional study in Japan. BMJ Open 2020; 10:e039040. [PMID: 32819954 PMCID: PMC7440713 DOI: 10.1136/bmjopen-2020-039040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES There is lack of evidence for the association between multimorbidity and diagnostic errors. Information on diagnostic errors from patients' perspectives is crucial to improve the diagnostic process. In this study, we aimed to investigate patient-reported diagnostic errors and to examine the relationship between multimorbidity and patient-reported diagnostic errors in the primary care setting. DESIGN Multicentre cross-sectional study. SETTING A primary care practice-based research network in Japan (25 primary care facilities). PARTICIPANTS Adult outpatients filled out a standardised questionnaire. PRIMARY OUTCOME MEASURE Patient-reported diagnostic errors. RESULTS Data collected from 1474 primary care outpatients were analysed. The number of participants who reported diagnostic errors was 57 (3.9%). Most of the missed diagnoses were common conditions in primary care, such as cancer, dermatitis and hypertension. After adjustment for possible confounders and clustering within facilities, multimorbidity was positively associated with patient-reported diagnostic errors (adjusted OR=1.83, 95% CI 1.01 to 3.31). The results of the sensitivity analysis were consistent with those of the primary analysis. CONCLUSIONS The present study showed a lower proportion of patients reporting experiences of diagnostic errors in primary care than those reported in previous studies in other countries. However, patients with multimorbidity are more likely to report diagnostic errors in primary care; thus, further research is necessary to improve the diagnostic process for patients with multimorbidity.
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Affiliation(s)
- Takuya Aoki
- Division of Clinical Epidemiology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoshi Watanuki
- Division of Emergency and General Medicine, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
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COPD overdiagnosis in primary care: a UK observational study of consistency of airflow obstruction. NPJ Prim Care Respir Med 2019; 29:33. [PMID: 31417094 PMCID: PMC6695394 DOI: 10.1038/s41533-019-0145-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 07/10/2019] [Indexed: 02/08/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is heterogeneous, but persistent airflow obstruction (AFO) is fundamental to diagnosis. We studied AFO consistency from initial diagnosis and explored factors associated with absent or inconsistent AFO. This was a retrospective observational study using patient-anonymised routine individual data in Care and Health Information Analytics (CHIA) database. Identifying a prevalent COPD cohort based on diagnostic codes in primary care records, we used serial ratios of forced expiratory volume in 1 s to forced vital capacity (FEV1/FVC%) from time of initial COPD diagnosis to assign patients to one of three AFO categories, according to whether all (persistent), some (variable) or none (absent) were <70%. We described respiratory prescriptions over 3 years (2011-2013) and used multivariable logistic regression to estimate odds of absent or variable AFO and potential predictors. We identified 14,378 patients with diagnosed COPD (mean ± SD age 68.8 ± 10.7 years), median (IQR) COPD duration of 60 (25,103) months. FEV1/FVC% was recorded in 12,491 (86.9%) patients: median (IQR) 5 (3, 7) measurements. Six thousand five hundred and fifty (52.4%) had persistent AFO, 4507 (36.1%) variable AFO and 1434 (11.5%) absent AFO. Being female, never smoking, having higher BMI or more comorbidities significantly predicted absent and variable AFO. Despite absent AFO, 57% received long-acting bronchodilators and 60% inhaled corticosteroids (50% and 49%, respectively, in those without asthma). In all, 13.1% of patients diagnosed with COPD had unrecorded FEV1/FVC%; 11.5% had absent AFO on repeated measurements, yet many received inhalers likely to be ineffective. Such prescribing is not evidence based and the true cause of symptoms may have been missed.
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Abad-Arranz M, Moran-Rodríguez A, Mascarós Balaguer E, Quintana Velasco C, Abad Polo L, Núñez Palomo S, Gonzálvez Rey J, Fernández Vargas AM, Hidalgo Requena A, Helguera Quevedo JM, García Pardo M, Lopez-Campos JL. Quantification of inaccurate diagnosis of COPD in primary care medicine: an analysis of the COACH clinical audit. Int J Chron Obstruct Pulmon Dis 2019; 14:1187-1194. [PMID: 31239656 PMCID: PMC6559770 DOI: 10.2147/copd.s199322] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 03/18/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Inaccurate diagnosis in COPD is a current problem with relevant consequences in terms of inefficient health care, which has not been thoroughly studied in primary care medicine. The aim of the present study was to evaluate the degree of inaccurate diagnosis in Primary Care in Spain and study the determinants associated with it. Methods: The Community Assessment of COPD Health Care (COACH) study is a national, observational, randomized, non-interventional, national clinical audit aimed at evaluating clinical practice for patients with COPD in primary care medicine in Spain. For the present analysis, a correct diagnosis was evaluated based on previous exposure and airway obstruction with and without the presence of symptoms. The association of patient-level and center-level variables with inaccurate diagnosis was studied using multivariate multilevel binomial logistic regression models. Results: During the study 4,307 cases from 63 centers were audited. The rate of inaccurate diagnosis was 82.4% (inter-regional range from 76.8% to 90.2%). Patient-related interventions associated with inaccurate diagnosis were related to active smoking, lung function evaluation, and specific therapeutic interventions. Center-level variables related to the availability of certain complementary tests and different aspects of the resources available were also associated with an inaccurate diagnosis. Conclusions: The prevalence data for the inaccurate diagnosis of COPD in primary care medicine in Spain establishes a point of reference in the clinical management of COPD. The descriptors of the variables associated with this inaccurate diagnosis can be used to identify cases and centers in which inaccurate diagnosis is occurring considerably, thus allowing for improvement.
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Affiliation(s)
- María Abad-Arranz
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain
| | | | | | | | | | | | | | | | | | | | | | - Jose Luis Lopez-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
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Overdiagnosis of COPD: precise definitions and proposals for improvement. Br J Gen Pract 2018; 67:183-184. [PMID: 28360069 DOI: 10.3399/bjgp17x690389] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Fernández-Villar A, Represas-Represas C, Mouronte-Roibás C, Ramos-Hernández C, Priegue-Carrera A, Fernández-García S, López-Campos JL. Reliability and usefulness of spirometry performed during admission for COPD exacerbation. PLoS One 2018; 13:e0194983. [PMID: 29579084 PMCID: PMC5868846 DOI: 10.1371/journal.pone.0194983] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 03/14/2018] [Indexed: 12/01/2022] Open
Abstract
Objectives Although not currently recommended, spirometry during hospitalization due to exacerbation of chronic obstructive pulmonary disease (COPD) is an opportunity to enhance the diagnosis of this disease. The aim of the present study was to assess the usefulness and reliability of spirometry before hospital discharge, comparing it to measurements obtained during clinical stability. Methods This prospective longitudinal observational study compares spirometry results before and 8 weeks after discharge in consecutive patients admitted for COPD exacerbation. Concordance between results was assessed by the Kappa index, intraclass correlation coefficient, and Bland-Altman graphs. Results From an initial population of 179 COPD patients, 100 completed the study (mean age 67.8 years, 83% men, 35% active smokers, FEV1 at clinical stability 40.3%). Forty-nine patients could not complete the study because they did not reach clinical stability. In three patients with obstructive spirometry during admission, the results were normal at follow-up. In the remaining patients, the COPD diagnosis was confirmed at stability with acceptable concordance. In 27 cases, spirometry improved more than 200 mL.No variables were found to be associated with this improvement or to explain it. Conclusions This study provides information on the role of spirometry prior to hospital discharge in patients admitted for COPD exacerbation, demonstrating that it is a valid and reproducible method, representing an opportunity toimprove COPD diagnosis.
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Affiliation(s)
- Alberto Fernández-Villar
- Pulmonary Department, Álvaro Cunqueiro Hospital, EOXI, Vigo, Spain
- NeumoVigoI+i Research Group, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Spain
- * E-mail:
| | - Cristina Represas-Represas
- Pulmonary Department, Álvaro Cunqueiro Hospital, EOXI, Vigo, Spain
- NeumoVigoI+i Research Group, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Spain
| | - Cecilia Mouronte-Roibás
- Pulmonary Department, Álvaro Cunqueiro Hospital, EOXI, Vigo, Spain
- NeumoVigoI+i Research Group, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Spain
| | - Cristina Ramos-Hernández
- Pulmonary Department, Álvaro Cunqueiro Hospital, EOXI, Vigo, Spain
- NeumoVigoI+i Research Group, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Spain
| | - Ana Priegue-Carrera
- Pulmonary Department, Álvaro Cunqueiro Hospital, EOXI, Vigo, Spain
- NeumoVigoI+i Research Group, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Spain
| | - Sara Fernández-García
- Pulmonary Department, Álvaro Cunqueiro Hospital, EOXI, Vigo, Spain
- NeumoVigoI+i Research Group, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Spain
| | - José Luis López-Campos
- Medical-Surgical Unit of Respiratory Diseases, Sevilla Biomedical Research Institute (IBiS), Virgen del Rocío University Hospital, Sevilla University, Spain
- CIBER of Respiratory Diseases (CIBERES), Health Institute Carlos III, Madrid, Spain
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Villar-Álvarez F, Moreno-Zabaleta R, Mira-Solves JJ, Calvo-Corbella E, Díaz-Lobato S, González-Torralba F, Hernando-Sanz A, Núñez-Palomo S, Salgado-Aranda S, Simón-Rodríguez B, Vaquero-Lozano P, Navarro-Soler IM. Do not do in COPD: consensus statement on overuse. Int J Chron Obstruct Pulmon Dis 2018; 13:451-463. [PMID: 29440883 PMCID: PMC5799849 DOI: 10.2147/copd.s151939] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background To identify practices that do not add value, cause harm, or subject patients with chronic obstructive pulmonary disease (COPD) to a level of risk that outweighs possible benefits (overuse). Methods A qualitative approach was applied. First, a multidisciplinary group of healthcare professionals used the Metaplan technique to draft and rank a list of overused procedures as well as self-care practices in patients with stable and exacerbated COPD. Second, in successive consensus-building rounds, description files were created for each "do not do" (DND) recommendation, consisting of a definition, description, quality of supporting evidence for the recommendation, and the indicator used to measure the degree of overuse. The consensus group comprised 6 pulmonologists, 2 general practitioners, 1 nurse, and 1 physiotherapist. Results In total, 16 DND recommendations were made for patients with COPD: 6 for stable COPD, 6 for exacerbated COPD, and 4 concerning self-care. Conclusion Overuse poses a risk for patients and jeopardizes care quality. These 16 DND recommendations for COPD will lower care risks and improve disease management, facilitate communication between physicians and patients, and bolster patient ability to provide self-care.
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Affiliation(s)
| | - Raúl Moreno-Zabaleta
- Pulmonology, Inpatient and Noninvasive Mechanical Ventilation, Hospital Universitario Infanta Sofía, Madrid
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Luis López-Campos J, Fernández-Villar A, Represas Represas C, Marín Barrera L, Botana Rial M, López Ramírez C, Casamor R. Evaluation of clinical variables according to follow-up times in COPD: results from ON-SINT cohort. Eur Clin Respir J 2017; 4:1394132. [PMID: 29201289 PMCID: PMC5700532 DOI: 10.1080/20018525.2017.1394132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 10/02/2017] [Indexed: 02/07/2023] Open
Abstract
Background: COPD is a chronic disease traditionally associated with increased symptoms as lung function deteriorates. Follow-up times in previous cohort studies were limited to a few years. Interestingly, newer longer observational studies show a more comprehensive picture on disease progression over time. Therefore, the question on the relevancy of the follow-up time in cohort studies remains open. Methods: The ON-SINT study is an observational, retrospective, nationwide, real-life cohort study, in which patients diagnosed with COPD were recruited between December 2011 and April 2013 by primary care (PC) and secondary care (SC) physicians. Patients were evaluated at the inclusion visit and at the initial visit when the diagnosis of COPD was first established. Distribution of lung function decline over the years was studied comparing those cases with longer follow-up times, with the median of the distribution as the cutoff point. Results: The sample included 1214 patients of which 857 (70.6%) were recruited by PC and 357 (29.4%) by SC physicians. Median follow-up time was 6.26 years. Mean annual change in the complete cohort were –4.5 (222) ml year–1 for FVC and 5.5 (134) ml year–1 for FEV1. We confirm the variable distribution of FEV1 decline and found that longer follow-up periods reduce this variability. Of note, FEV1 decline was different between groups (shorter: 19.7 [180.4] vs longer: –9.7 [46.9]; p = 0.018). Further, our data revealed differences in the clinical presentation according to follow-up times, with special emphasis on dyspnea (OR: 1.035; 95%CI: 1.014–1.056), exacerbations (OR 1.172; 95%CI 1.045–1.315) and CAT scores (OR 1.047; 95%CI 1.019–1.075) being associated with longer follow-up times. Conclusions: This study describes the impact of follow-up periods on lung function variability, and reveals differences in clinical presentation according to follow-up times, with special emphasis on dyspnea, exacerbations and CAT scores.
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Affiliation(s)
- José Luis López-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Sevilla, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - Lucía Marín Barrera
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Sevilla, Spain
| | - Maribel Botana Rial
- Servicio de Neumología, Complexo Hospitalario de Vigo, Sevilla, Spain.,Instituto de Investigación biomédica de Vigo (IBIV), Vigo, Spain
| | - Cecilia López Ramírez
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Sevilla, Spain
| | - Ricard Casamor
- Departamento Médico de Novartis Farmacéutica, Novartis España, Barcelona, Spain
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Arkhipov V, Arkhipova D, Miravitlles M, Lazarev A, Stukalina E. Characteristics of COPD patients according to GOLD classification and clinical phenotypes in the Russian Federation: the SUPPORT trial. Int J Chron Obstruct Pulmon Dis 2017; 12:3255-3262. [PMID: 29138554 PMCID: PMC5680946 DOI: 10.2147/copd.s142997] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background The high prevalence of COPD in the Russian Federation has been demonstrated in several epidemiological studies. However, there are still no data on the clinical characteristics of these patients according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) groups and phenotypes, which could provide additional understanding of the burden of COPD, routine clinical practice, and ways to improve the treatment of patients with COPD in Russia. Patients and methods SUPPORT was an observational multicenter study designed to obtain data about the distribution of patients with previously diagnosed COPD according to the severity of bronchial obstruction, symptom severity, risk of exacerbation, COPD phenotypes, and treatment of COPD. We included patients with a previous diagnosis of COPD who visited one of 33 primary-care centers for any reason in 23 cities in Russia. Results Among the 1,505 patients with a previous diagnosis of COPD who attended the primary-care centers and were screened for the study, 1,111 had a spirometry-confirmed diagnosis and were included in the analysis. Up to 53% of the patients had severe or very severe COPD (GOLD stages III–IV), and 74.3% belonged to the GOLD D group. The majority of patients were frequent exacerbators (exacerbators with chronic bronchitis [37.3%], exacerbators without chronic bronchitis [14%]), while 35.8% were nonexacerbators and 12.9% had asthma–COPD overlap. Among the GOLD D group patients, >20% were treated with only short-acting bronchodilators. Conclusion COPD is still misdiagnosed in primary care in Russia. COPD patients in primary care are usually GOLD D with frequent exacerbations and are often treated with only short-acting bronchodilators.
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Affiliation(s)
- Vladimir Arkhipov
- Clinical Pharmacology and Therapy Department, Russian Medical Academy of Postgraduate Education, Moscow, Russian Federation
| | - Daria Arkhipova
- Clinic Pharmacology and Propaedeutic Internal Diseases Department, First Moscow State Medical University, Moscow, Russian Federation
| | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
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Naveiro-Rilo JC, García García S, Flores-Zurutuza L, Carazo Fernández L, Domínguez Fernández C, Palomo García JL. [Utility of normality low limit of spirometry in diagnosed COPD patients]. REVISTA DE CALIDAD ASISTENCIAL : ORGANO DE LA SOCIEDAD ESPANOLA DE CALIDAD ASISTENCIAL 2017; 32:262-268. [PMID: 28863965 DOI: 10.1016/j.cali.2017.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/02/2017] [Accepted: 05/05/2017] [Indexed: 06/07/2023]
Abstract
AIM To evaluate the differences in COPD patients below the lower limit of normal (LLN) of the fixed ratio FEV1/FVC < 0.70 and those above this limit. PATIENTS AND METHODS Cross-sectional study. COPD patients between 40 and 85 years old included in primary care clinical record database were randomly selected. Baseline and postbronchodilator spirometries were performed. Two groups of patients were established: FEV1/FVC<0.70 and ≤LIN (group1) and FEV/FVC<0.70 and >LIN (group 2). Sociodemographic, clinical, pulmonary obstruction, quality of life and attendance to health services variables were measured. The results of both groups were compared. RESULTS 22.3% of the subjects were misdiagnosed FEV1/FVC < 0,70. Patients in group 2 (FEV1/FVC<0.70 y > LLN) are diagnosed at an older age, they have a lower exposure to tobacco and better pulmonary function (FEV1: 74.9% vs 54.6%). 35.5% of those patients belong to stage i of GOLD, vs 8.5%, this patients have an increased comorbidity. Patients in group 1 have more COPD exacerbations, worse quality of life, a higher BODEx index 2,3 (1.8) vs 1.1 (1.5); 55.1% of those patients were high risk patients (GoldC or Gold D). Diagnose before being 56 years old, an increased exposure to tobacco, the FEV>50%, and a lower comorbidity are associated with a greater chance of suffering COPD with LLN criteria. CONCLUSION We obtain two groups of patients with differentiated clinical characteristics if we use LLN. Subjects with FEV1/FVC<0.7 and >LLN have less obstruction, less severity and more comorbidity, suggesting the possibility of overdiagnosis or misdiagnosis. On the other hand, younger age at the time of diagnosis, higher tobacco consumption and more severe obstruction are related with FEV1/FVC >0.70 and<LLN (group 1).
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Hangaard S, Helle T, Nielsen C, Hejlesen OK. Causes of misdiagnosis of chronic obstructive pulmonary disease: A systematic scoping review. Respir Med 2017; 129:63-84. [DOI: 10.1016/j.rmed.2017.05.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 05/16/2017] [Accepted: 05/27/2017] [Indexed: 12/11/2022]
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Golpe R, Martín-Robles I, Sanjuán-López P. Combustión de biomasa como factor de riesgo para enfermedad pulmonar obstructiva crónica en España. Arch Bronconeumol 2017; 53:289. [DOI: 10.1016/j.arbres.2016.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 11/27/2016] [Indexed: 10/20/2022]
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García García S, Carazo Fernández L, Juan García J, Naveiro Rilo JC. [Chronic obstructive pulmonary disease in real life. LEONPOC study]. Aten Primaria 2017; 49:603-610. [PMID: 28292581 PMCID: PMC6876058 DOI: 10.1016/j.aprim.2017.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 12/22/2016] [Accepted: 01/02/2017] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate different characteristics of COPD patients according to phenotypes and GOLD guidelines.according to GesEPOC phenotypes and GOLD 2011 ABCD guidelines and pharmacological treatment agreement. DESIGN Cross-sectional survey. LOCATION COPD patients aged 40-85 from León were randomly selected from Primary Care database, MEDORA. PARTICIPANTS 5222 eligible COPD patients were collected from MEDORA database. We calculated a sample size of 734 patients and finally studied 577 of them. MAIN MEASUREMENTS Patientś clinical, functional and health related quality of life information were collected. Spirometry and postbroncodilator test were performed. RESULTS A total of 577 patients were included in this study. 28.7% of them did not have a spirometry recorded in their files. 123 patients had a normal or non-obstructive spirometry pattern, so they were excluded from a COPD diagnostic. With regard to treatments, there was an overprescribing of inhaled steroids in patients from GOLD A and B groups, and also in patients with the called exacerbator phenotype (GesEPOC). CONCLUSION Although there have been several published guidelines, management of COPD patients in real life should be improved.
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Affiliation(s)
- Silvia García García
- Sección de Neumología, Complejo Asistencial Universitario de León, León, España.
| | | | - Javier Juan García
- Sección de Neumología, Complejo Asistencial Universitario de León, León, España
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López-Campos JL, Fernández-Villar A, Calero-Acuña C, Represas-Represas C, López-Ramírez C, Leiro Fernández V, Casamor R. Occupational and Biomass Exposure in COPD: Results of a Cross-Sectional Analysis of the On-Sint Study. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.arbr.2016.06.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Barbosa-Lorenzo R, Ruano-Ravina A, Ramis R, Aragonés N, Kelsey KT, Carballeira-Roca C, Fernández-Villar A, López-Abente G, Barros-Dios JM. Residential radon and COPD. An ecological study in Galicia, Spain. Int J Radiat Biol 2016; 93:222-230. [PMID: 27778529 DOI: 10.1080/09553002.2017.1238526] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Radon is a human lung carcinogen but it might be linked with other respiratory diseases. We aimed to assess the relationship between residential radon exposure and COPD (chronic obstructive pulmonary disease) prevalence and hospital admissions at a municipal level. MATERIALS AND METHODS We designed an ecological study where we included those municipalities with at least three radon measurements. Using mixed Poisson regression models, we calculated the relative risk (RR) for COPD for each 100 Bq/m3 of increase in radon concentration and also the relative risk for COPD using a cut-off point of 50 Bq/m3. We did not have individual data on cigarette smoking and therefore we used a proxy (bladder cancer standardized mortality rate) that has proved to account for tobacco consumption. We performed separate analyses for sex and also sensitivity analysis considering age and rurality. RESULTS A total of 3040 radon measurements and 49,393 COPD cases were included. The relative risk for COPD prevalence was 0.95 (95% CI: 0.92-0.97) while for hospital admissions the RR was 1.04 (95% CI: 1.00-1.10) for each 100 Bq/m3. Relative risks were higher for women compared to men. Using a categorical analysis with a cut-off point of 50 Bq/m3, the RR for COPD prevalence was 1.06 (95% CI: 1.02-1.10) and for hospital admissions it was 1.08 (95% CI: 1.00-1.17) for women living in municipalities with more than 50 Bq/m3. All risks were also higher for women. No relevant differences were observed for age, rurality or other categories for radon exposure. CONCLUSION While the influence of radon on COPD prevalence is unclear depending on the approach used, it seems that residential radon might increase the risk of hospital admissions in COPD patients. Women have a higher risk than men in all situations. Since this is an ecological study, results should be interpreted cautiously.
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Affiliation(s)
- Raquel Barbosa-Lorenzo
- a Department of Preventive Medicine & Public Health , University of Santiago de Compostela , Santiago de Compostela , Spain.,b Preventive Medicine and Public Health Unit , Monforte de Lemos Local Hospital , Monforte de Lemos , Spain
| | - Alberto Ruano-Ravina
- a Department of Preventive Medicine & Public Health , University of Santiago de Compostela , Santiago de Compostela , Spain.,c Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública: CIBERESP) , Spain.,d Department of Epidemiology, Brown School of Public Health , Brown University , Providence , RI , USA
| | - Rebeca Ramis
- c Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública: CIBERESP) , Spain.,e Cancer and Environmental Epidemiology Unit, National Center for Epidemiology , Carlos III Institute of Health , Madrid , Spain
| | - Nuria Aragonés
- c Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública: CIBERESP) , Spain.,e Cancer and Environmental Epidemiology Unit, National Center for Epidemiology , Carlos III Institute of Health , Madrid , Spain
| | - Karl T Kelsey
- d Department of Epidemiology, Brown School of Public Health , Brown University , Providence , RI , USA
| | - Consuelo Carballeira-Roca
- f Clinical Coding and Analysis Department, Galician Health Authority, Galicia Regional Authority , Santiago de Compostela , Spain
| | | | - Gonzalo López-Abente
- c Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública: CIBERESP) , Spain.,e Cancer and Environmental Epidemiology Unit, National Center for Epidemiology , Carlos III Institute of Health , Madrid , Spain
| | - Juan M Barros-Dios
- a Department of Preventive Medicine & Public Health , University of Santiago de Compostela , Santiago de Compostela , Spain.,c Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública: CIBERESP) , Spain.,h Preventive Medicine and Public Health Unit , Santiago de Compostela University Teaching Hospital , Santiago de Compostela , Spain
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Llordés M, Zurdo E, Jaén Á, Vázquez I, Pastrana L, Miravitlles M. Which is the Best Screening Strategy for COPD among Smokers in Primary Care? COPD 2016; 14:43-51. [PMID: 27797591 DOI: 10.1080/15412555.2016.1239703] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We developed a questionnaire to detect cases of chronic obstructive pulmonary disease (COPD) and compared its reliability with other strategies. In order to develop the new questionnaire (COPD screening questionnaire from Terrassa [EGARPOC]) we used data from an epidemiological study on the prevalence of COPD in smokers and calculated the odds ratio for each variable showing significance for the diagnosis of COPD on regression analysis. For comparison among questionnaires and the portable spirometer COPD-6, a cross-sectional multicenter study was performed. The study included 407 smokers or ex-smokers over the age of 40 years with no known diagnosis of COPD, who completed the different questionnaires (EGARPOC, Respiratory Health Screening Questionnaire, COPD-population screener and 2 questions) and underwent spirometry with the COPD-6. We determined the sensitivity, specificity, positive and negative predictive values (S, Sp, PPV and NPV, respectively) and the area under the receiver operating characteristic ROC curve (AUC ROC) of all the questionnaires and the different COPD-6 cut-offs. The prevalence of COPD was 26.3%. The EGARPOC questionnaire showed an S of 81.8%, an Sp of 70.6%, and an NPV of 91.8%; 73.3% of individuals were correctly classified, and the AUC ROC was 0.841. On comparing the questionnaires by the Chi-square test, the 2-question questionnaire showed the worst discrimination; while with an optimal cut-off of forced expiratory volume in one 1 second (FEV1)/FEV6 of 0.78, the COPD-6 was significantly better than the questionnaires in the detection of COPD. Using a cut-off of FEV1/FEV6 of 0.78 the COPD-6 was found to be the best screening tool for COPD in primary care compared to the questionnaires tested, which did not show differences among them.
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Affiliation(s)
- Montserrat Llordés
- a CAP Terrassa Sud. Hospital Universitario Mutua de Terrassa, Universidad de Barcelona , Barcelona , Spain
| | - Elba Zurdo
- a CAP Terrassa Sud. Hospital Universitario Mutua de Terrassa, Universidad de Barcelona , Barcelona , Spain
| | - Ángeles Jaén
- b Coordinació projectes recerca, Fundació Docència i Recerca Mutua de Terrassa , Terrassa , Spain
| | - Inmaculada Vázquez
- a CAP Terrassa Sud. Hospital Universitario Mutua de Terrassa, Universidad de Barcelona , Barcelona , Spain
| | - Luís Pastrana
- c CAP Terrassa Oest. Hospital Universitario Mutua de Terrassa, Universidad de Barcelona , Barcelona , Spain
| | - Marc Miravitlles
- d Pneumology Department , Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES) , Barcelona , Spain
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López-Campos JL, Fernández-Villar A, Calero-Acuña C, Represas-Represas C, López-Ramírez C, Fernández VL, Casamor R. Occupational and Biomass Exposure in Chronic Obstructive Pulmonary Disease: Results of a Cross-Sectional Analysis of the On-Sint Study. Arch Bronconeumol 2016; 53:7-12. [PMID: 27432162 DOI: 10.1016/j.arbres.2016.04.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 04/19/2016] [Accepted: 04/20/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although tobacco smoke is the main risk factor for chronic obstructive pulmonary disease (COPD), other inhaled toxics have also been associated with the disease. The present study analyzes data from exposure to these substances in a cohort of patients with COPD and assesses their impact on the clinical presentation of the disease. METHODS This is a cross-sectional analysis of the Clinical presentation, diagnosis and course of chronic obstructive pulmonary disease (On-Sint) study. All patients were smokers or ex-smokers as per protocol. In addition, during the inclusion visit patients were enquired about their occupational and biomass exposure history. The clinical features of patients with and without an added risk factor to tobacco were compared and those significant were entered in a multivariate logistic regression analysis, expressed as odds ratio (OR). RESULTS The sample size was 1214 patients with COPD, of which 1012 (83.4%) had tobacco as the only risk factor and 202 (16.6%) had additional ones, mainly 174 (14.3%) with occupational gases and 32 (2.6%) with biomass exposure. The geographical distribution of this exposure showed a preference for the northern parts of the country and the East coast. The biomass exposure was rather low. Male gender (OR: 2.180), CAT score (OR: 1.036) and the use of long-term oxygen therapy (OR: 1.642) were associated with having an additional risk factor in the multivariate analysis. CONCLUSIONS Occupational exposures are more common than biomass in Spain. COPD caused by tobacco plus other inhalants has some differential features and a more impaired quality of life.
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Affiliation(s)
- José Luis López-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Sevilla, España; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España.
| | - Alberto Fernández-Villar
- Servicio de Neumología, Instituto de Investigación Biomédica de Vigo (IBIV), Complexo Hospitalario de Vigo, Vigo, Pontevedra, España
| | - Carmen Calero-Acuña
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Sevilla, España
| | - Cristina Represas-Represas
- Servicio de Neumología, Instituto de Investigación Biomédica de Vigo (IBIV), Complexo Hospitalario de Vigo, Vigo, Pontevedra, España
| | - Cecilia López-Ramírez
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Sevilla, España
| | - Virginia Leiro Fernández
- Servicio de Neumología, Instituto de Investigación Biomédica de Vigo (IBIV), Complexo Hospitalario de Vigo, Vigo, Pontevedra, España
| | - Ricard Casamor
- Departamento Médico, Novartis Farmacéutica, Barcelona, España
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Zeng Y, Xu J, Cai S, Jiang F, Hu A, Liu H, Bei C, Chen P. Follow-up study on management of chronic obstructive pulmonary disease in Hunan Province, the People's Republic of China. Int J Chron Obstruct Pulmon Dis 2016; 11:981-9. [PMID: 27274219 PMCID: PMC4869625 DOI: 10.2147/copd.s99135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background In 2009, our study showed an extreme imbalance and disparity in COPD-related health resources allocation at three levels of public hospitals (PHs) in Hunan Province of the People’s Republic of China, especially in second-level PHs. Moreover, most Chinese citizens accept their health care services in first- and second-level PHs for economic and geographical reasons, as well as because of the incomplete transfer system in the health care services. To improve diagnosis and treatment ability of pulmonologists in second-level PHs, an intervention that provided training combined with spirometry equipment was carried out in three PHs from six second-level PHs. The aim of this follow-up study was to evaluate the changes associated with COPD-related health resources allocation and the effect of the intervention 4 years later. Methods The data regarding the availability of spirometers, inhalation agents for COPD, and COPD-related health care education for local residents were collected from 57 PHs in 2009 and 48 PHs in 2013. Pulmonologists working in these PHs were asked to complete a questionnaire individually. Six second-level PHs (three in the intervention group and the other three in the control group [without training and spirometry equipment]) that further took part in the survey in 2009 were reevaluated to determine the doubtful diagnostic ratio and the confirmation ratio of COPD. The differences between 2009 and 2013 data was analyzed. Results A total of 762 questionnaires were completed. Compared with 2009, spirometer-equipped ratio raised from 40% to 69% in 2013 (P=0.03). The overall inhalation agent-equipped ratio increased from 58% in 2009 to 88% in 2013 (P=0.001). The total rate of health education raised from 35% in 2009 to 63% in 2013 (P=0.04). In total, 204 pulmonologists from six PHs (selected for study in 2009) completed the questionnaires in 2013. The median score of COPD knowledge questionnaire in the intervention group was higher than that of the control group (80 vs 50, respectively, P<0.01). Further, the clinical doubtful diagnostic ratio (15%) and the diagnosis ratio of COPD (3%) in the intervention group were higher than in the control group (4% and 1%, respectively, P<0.05) even after 4 years. Conclusion COPD-related health resources allocation improved in the 4 years following intervention at three levels of PHs in the People’s Republic of China. Short-term training combined with spirometry equipment had a sustained effect on improving the physicians’ understanding and diagnosis ability of COPD.
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Affiliation(s)
- Yuqin Zeng
- Department of Respiratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Jianxian Xu
- Department of Respiratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Shan Cai
- Department of Respiratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Fen Jiang
- Department of Respiratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Anmei Hu
- Department of Respiratory Medicine, Shenzhen City Baoan District Central Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Huayun Liu
- Department of Respiratory Medicine, The Yueyang First People's Hospital, Yueyang, Hunan, People's Republic of China
| | - Chengli Bei
- Department of Respiratory Medicine, Changsha Central Hospital, Changsha, People's Republic of China
| | - Ping Chen
- Department of Respiratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
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Kasteleyn MJ, Bonten TN, Taube C, Chavannes NH. Coordination of care for patients with COPD: Clinical points of interest. INTERNATIONAL JOURNAL OF CARE COORDINATION 2015. [DOI: 10.1177/2053434515620223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The management of care of chronic obstructive pulmonary disease improved over the last years but is still very complex. Both over- and underdiagnosis are often reported and misclassification of disease severity is common. Differentiating between chronic obstructive pulmonary disease, asthma and asthma-chronic obstructive pulmonary disease overlap syndrome remains difficult. Much is known about the effectiveness of treatment approaches in chronic obstructive pulmonary disease, but patients are often not treated according to the guidelines, and we need more evidence on effectiveness in phenotypes of chronic obstructive pulmonary disease. Care coordination is of great importance and can help to further improve care for chronic obstructive pulmonary disease patients. Pulmonary rehabilitation and self-management are considered important aspects of chronic obstructive pulmonary disease care. In our opinion, there is a major role for eHealth to improve coordination of care of chronic obstructive pulmonary disease.
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Panagioti M, Stokes J, Esmail A, Coventry P, Cheraghi-Sohi S, Alam R, Bower P. Multimorbidity and Patient Safety Incidents in Primary Care: A Systematic Review and Meta-Analysis. PLoS One 2015; 10:e0135947. [PMID: 26317435 PMCID: PMC4552710 DOI: 10.1371/journal.pone.0135947] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 07/29/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Multimorbidity is increasingly prevalent and represents a major challenge in primary care. Patients with multimorbidity are potentially more likely to experience safety incidents due to the complexity of their needs and frequency of their interactions with health services. However, rigorous syntheses of the link between patient safety incidents and multimorbidity are not available. This review examined the relationship between multimorbidity and patient safety incidents in primary care. METHODS We followed our published protocol (PROSPERO registration number: CRD42014007434). Medline, Embase and CINAHL were searched up to May 2015. Study design and quality were assessed. Odds ratios (OR) and 95% confidence intervals (95% CIs) were calculated for the associations between multimorbidity and two categories of patient safety outcomes: 'active patient safety incidents' (such as adverse drug events and medical complications) and 'precursors of safety incidents' (such as prescription errors, medication non-adherence, poor quality of care and diagnostic errors). Meta-analyses using random effects models were undertaken. RESULTS Eighty six relevant comparisons from 75 studies were included in the analysis. Meta-analysis demonstrated that physical-mental multimorbidity was associated with an increased risk for 'active patient safety incidents' (OR = 2.39, 95% CI = 1.40 to 3.38) and 'precursors of safety incidents' (OR = 1.69, 95% CI = 1.36 to 2.03). Physical multimorbidity was associated with an increased risk for active safety incidents (OR = 1.63, 95% CI = 1.45 to 1.80) but was not associated with precursors of safety incidents (OR = 1.02, 95% CI = 0.90 to 1.13). Statistical heterogeneity was high and the methodological quality of the studies was generally low. CONCLUSIONS The association between multimorbidity and patient safety is complex, and varies by type of multimorbidity and type of safety incident. Our analyses suggest that multimorbidity involving mental health may be a key driver of safety incidents, which has important implication for the design and targeting of interventions to improve safety. High quality studies examining the mechanisms of patient safety incidents in patients with multimorbidity are needed, with the goal of promoting effective service delivery and ameliorating threats to safety in this group of patients.
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Affiliation(s)
- Maria Panagioti
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Jonathan Stokes
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre (Greater Manchester PSTRC), Manchester Academic Health Science Centre University of Manchester, Manchester, United Kingdom
| | - Aneez Esmail
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre (Greater Manchester PSTRC), Manchester Academic Health Science Centre University of Manchester, Manchester, United Kingdom
| | - Peter Coventry
- NIHR Collaboration for Leadership in Applied Health Research and Care—Greater Manchester and Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Sudeh Cheraghi-Sohi
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre (Greater Manchester PSTRC), Manchester Academic Health Science Centre University of Manchester, Manchester, United Kingdom
| | - Rahul Alam
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre (Greater Manchester PSTRC), Manchester Academic Health Science Centre University of Manchester, Manchester, United Kingdom
| | - Peter Bower
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre (Greater Manchester PSTRC), Manchester Academic Health Science Centre University of Manchester, Manchester, United Kingdom
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López Ramírez C, Calero Acuña C, Represas Represas C, Aballe Santos L, Casamor R, Fernández-Villar A, López-Campos JL. Evaluation of the visit frequency and the use of questionnaires and indices for COPD: a national survey from the On-Sint study. CLINICAL RESPIRATORY JOURNAL 2015; 11:367-373. [PMID: 26149089 DOI: 10.1111/crj.12349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 05/23/2015] [Accepted: 06/29/2015] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Despite widespread recommendations to use standardized questionnaires and multidimensional indices for the assessment of patients with chronic obstructive pulmonary disease (COPD), few data are available on the application of these tools in clinical practice. This study evaluates the attitude of physicians participating in the On-Sint cohort toward the use of health status questionnaires and multidimensional indices, as well as toward the frequency of visits and spirometry in primary care and specialized care. METHODS During the constitution of the On-Sint cohort, the participating physicians were surveyed about their clinical practice. They were questioned on the frequency of spirometry and visits and on the use of various questionnaires and indices. The health status questionnaires assessed were St. George's respiratory questionnaire, chronic respiratory questionnaire, airways questionnaire 20 and COPD assessment test (CAT). Physicians were also asked about the use of the medical research council (MRC) dyspnea scale and multidimensional indices such as body mass index, airflow obstruction, dyspnea, exercise capacity (BODE). RESULTS Of the 356 physicians who participated in the study, 258 (72.5 %) completed the investigator's questionnaire (185 primary care, 73 specialized care). Nonscheduled visits were inversely proportional to the severity of COPD. Overall, 34.1% reported using health status questionnaires, mainly CAT (20.9%). We found differences between primary and specialized care in the use of multidimensional indices (84.9% vs 47.6%; P < 0.001). Of all the participants, 33.3% reported using the MRC scale and 28.7% the BODE index. CONCLUSIONS Multidimensional indices and questionnaires are not commonly used with some differences between primary care and specialized care physicians. There is a considerable variability in the frequency of follow-up visits and spirometry.
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Affiliation(s)
- Cecilia López Ramírez
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocio/Universidad de Sevilla, Spain
| | - Carmen Calero Acuña
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocio/Universidad de Sevilla, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Cristina Represas Represas
- Servicio de Neumología. Instituto de Investigación Biomédica de Vigo (IBIV), Complexo Hospitalario de Vigo, Spain
| | - Luz Aballe Santos
- Servicio de Neumología. Instituto de Investigación Biomédica de Vigo (IBIV), Complexo Hospitalario de Vigo, Spain
| | - Ricard Casamor
- Medical Department, Novartis Farmacéutica, Barcelona, Spain
| | - Alberto Fernández-Villar
- Servicio de Neumología. Instituto de Investigación Biomédica de Vigo (IBIV), Complexo Hospitalario de Vigo, Spain
| | - José Luis López-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocio/Universidad de Sevilla, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
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Lopez-Campos JL, Fernandez-Villar A, Calero-Acuña C, Represas-Represas C, Lopez-Ramírez C, Fernández VL, Soler-Cataluña JJ, Casamor R. Evaluation of the COPD Assessment Test and GOLD patient types: a cross-sectional analysis. Int J Chron Obstruct Pulmon Dis 2015; 10:975-84. [PMID: 26064045 PMCID: PMC4455854 DOI: 10.2147/copd.s82781] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The COPD Assessment Test (CAT) has been recently developed to quantify COPD impact in routine practice. However, no relationship with other measures in the Global Initiative for Obstructive Lung Disease (GOLD) strategy has been evaluated. The present study aimed to evaluate the relationship of the CAT with other GOLD multidimensional axes, patient types, and the number of comorbidities. Methods This was a cross-sectional analysis of the Clinical presentation, diagnosis, and course of chronic obstructive pulmonary disease (On-Sint) study. The CAT score was administered to all participants at the inclusion visit. A GOLD 2011 strategy consisting of modified Medical Research Council scale (MRC) scores was devised to study the relationship between the CAT, and GOLD 2011 axes and patient types. The relationship with comorbidities was assessed using the Charlson comorbidity index, grouped as zero, one to two, and three or more. Results The CAT questionnaire was completed by 1,212 patients with COPD. The CAT maintained a relationship with all the three axes, with a ceiling effect for dyspnea and no distinction between mild and moderate functional impairment. The CAT score increased across GOLD 2011 patient types A–D, with similar scores for types B and C. Within each GOLD 2011 patient type, there was a considerably wide distribution of CAT values. Conclusion Our study indicates a correlation between CAT and the GOLD 2011 classification axes as well as the number of comorbidities. The CAT score can help clinicians, as a complementary tool to evaluate patients with COPD within the different GOLD patient types.
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Affiliation(s)
- Jose Luis Lopez-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocio/Universidad de Sevilla, Sevilla, Spain ; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Alberto Fernandez-Villar
- Servicio de Neumología, Instituto de Investigación Biomédica de Vigo (IBIV), Complexo Hospitalario de Vigo, Vigo, Spain
| | - Carmen Calero-Acuña
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocio/Universidad de Sevilla, Sevilla, Spain
| | - Cristina Represas-Represas
- Servicio de Neumología, Instituto de Investigación Biomédica de Vigo (IBIV), Complexo Hospitalario de Vigo, Vigo, Spain
| | - Cecilia Lopez-Ramírez
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocio/Universidad de Sevilla, Sevilla, Spain
| | - Virginia Leiro Fernández
- Servicio de Neumología, Instituto de Investigación Biomédica de Vigo (IBIV), Complexo Hospitalario de Vigo, Vigo, Spain
| | - Juan Jose Soler-Cataluña
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain ; Servicio de Neumología Hospital Arnau de Vilanova, Valencia, Spain
| | - Ricard Casamor
- Departamento Médico de Novartis Farmacéutica, Barcelona, Spain
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