Detection of Chronic Obstructive Pulmonary Disease in Primary Care in Salzburg, Austria: Findings from the Real World

Weiss, Gertraud; Steinacher, Ina; Lamprecht, Bernd; Schirnhofer, Lea; Kaiser, Bernhard; Sönnichsen, Andreas; Studnicka, Michael

doi:10.1159/000354796

Cited by 19 publications

(39 citation statements)

References 34 publications

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“…Furthermore, it is predicted to become the third leading cause of death worldwide by 2020 [3,4]. Recently, COPD has been recognized as a systemic disease; many patients with COPD have comorbidities that may have a significant impact on their quality of life and their prognosis [5,6].…”

Section: Introductionmentioning

confidence: 99%

Impact of Airflow Limitation on Carotid Atherosclerosis in Coronary Artery Disease Patients

Hamrah

Suzuki²,

Ishii³

et al. 2015

Respiration

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Background: Both airflow limitation and smoking are established cardiovascular risk factors. However, their interaction as risk factors for the development of atherosclerosis in coronary artery disease patients remains unclear. Objectives: To evaluate the effect of the interaction between airflow limitation and smoking status on the severity of carotid atherosclerosis. Methods: We categorized the 234 enrolled patients with coronary artery disease into four groups: never-smokers with normal pulmonary function (group A), never-smokers with airflow limitation (group B), ever-smokers with normal pulmonary function (group C), and ever-smokers with airflow limitation (group D). Results: The prevalence of airflow limitation in the enrolled patients was 23.1% (ever-smokers: 15.8%, never-smokers: 7.3%). The prevalence of severe carotid atherosclerosis was 28.2, 29.4, 41.3, and 45.9%, respectively, in the four groups (group D vs. group A, p = 0.035). Even after multivariate adjusting for confounding factors, ever-smokers with airflow limitation were independently associated with severe carotid atherosclerosis (odds ratio 2.89, 95% confidence interval, 1.19-7.00, p = 0.019). Conclusions: Ever-smokers with airflow limitation were significantly associated with severe carotid atherosclerosis among patients with coronary artery disease. These findings also provide additional insight into the correlation between airflow limitation and poor cardiovascular clinical outcomes.

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Section: Introductionmentioning

confidence: 99%

Impact of Airflow Limitation on Carotid Atherosclerosis in Coronary Artery Disease Patients

Hamrah

Suzuki²,

Ishii³

et al. 2015

Respiration

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“…Detailed information on characteristics of this study sample can be found elsewhere. 33 In the primary care validation sample, prevalence of PBD FEV 1 /FVC < LLN was 9.8%. Population characteristics (age, gender, smoking status and education) were not significantly different between the BOLD and the primary care based validation sample (data not shown).…”

Section: Resultsmentioning

confidence: 89%

“…33 Fifty percent of the invited primary care offices were willing to participate in this study. The patients’ mean participation rate in the offices was 12.5%.…”

Section: Resultsmentioning

confidence: 99%

“…Population characteristics (age, gender, smoking status and education) were not significantly different between the BOLD and the primary care based validation sample (data not shown). 33 …”

Section: Resultsmentioning

confidence: 99%

“…33 It was our aim to develop a brief, simple, and easy to use COPD questionnaire to pre-select subjects for spirometry.…”

Section: Introductionmentioning

confidence: 99%

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Development and validation of the Salzburg COPD-screening questionnaire (SCSQ): a questionnaire development and validation study

Weiss

Steinacher

Lamprecht

et al. 2017

npj Prim Care Resp Med

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Chronic obstructive pulmonary disease prevalence rates are still high. However, the majority of subjects are not diagnosed. Strategies have to be implemented to overcome the problem of under-diagnosis. Questionnaires could be used to pre-select subjects for spirometry and thereby help reducing under-diagnosis. We report a brief, simple, self-administrable and validated chronic obstructive pulmonary disease questionnaire to increase the pre-test probability for chronic obstructive pulmonary disease diagnosis in subjects undergoing confirmatory spirometry. In 2005, we completed the Austrian Burden of Obstructive Lung Disease-study in 1258 subjects aged >40 years. Post-bronchodilator spirometry was performed, and non-reversible airflow limitation defined by FEV1/FVC ratio below the lower limit of normal. Questions from the Salzburg chronic obstructive pulmonary disease screening-questionnaire were selected using a logistic regression model, and risk scores were based on regression-coefficients. A training sub-sample (n = 800) was used to create the score, and a test sub-sample (n = 458) was used to test it. In 2008, an external validation study was done, using the same protocol in 775 patients from primary care. The Salzburg chronic obstructive pulmonary disease screening questionnaire was composed of items related to “breathing problems”, “wheeze”, “cough”, “limitation of physical activity”, and “smoking”. At the >=2 points cut-off of the Salzburg chronic obstructive pulmonary disease screening questionnaire, sensitivity was 69.1% [95%CI: 56.6%; 79.5%], specificity 60.0% [95%CI: 54.9%; 64.9%], the positive predictive value 23.2% [95%CI: 17.7%; 29.7%] and the negative predictive value 91.8% [95%CI: 87.5%; 95.7%] to detect post bronchodilator airflow limitation. The external validation study in primary care confirmed these findings. The Salzburg chronic obstructive pulmonary disease screening questionnaire was derived from the highly standardized Burden of Obstructive Lung Disease study. This validated and easy to use questionnaire can help to increase the efficiency of chronic obstructive pulmonary disease case-finding.

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Improving quality of care in general practices by self-audit, benchmarking and quality circles

Mahlknecht

Abuzahra

Piccoliori³

et al. 2016

Wien Klin Wochenschr

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SummaryGuideline adherence of general practitioners (GP) regarding treatment of chronic conditions shows room for improvement. Thus, concepts have to be designed to promote quality of care. The aim of the interventional study “Improvement of Quality by Benchmarking” was to assess whether quality can be improved by self-auditing, benchmarking and quality circles in Salzburg (Austria) and South Tyrol (Italy). In this publication we present the Austrian results. Quality indicators were developed in a consensus process for eight chronic diseases based on pre-existing quality management systems. A quality score consisting of 35 indicators was calculated (0–5 points per indicator depending on fulfilment, maximum 175 points). Data were extracted from the electronic health records of participating practices in 2012, 2013 and 2014. A statistical pre-post analysis was performed using Wilcoxon signed-rank tests. A total of 20 GPs participated in the project. The mean quality score increased from 62.0 at baseline to 84.0 at the second follow-up (p = 0.003). Regarding the individual quality indicators, strong improvements were achieved between baseline and first follow-up, especially in process indicators concerning documentation. Between the first and second follow-up, quality remained in most cases at the same level. The validity of results is limited because of structural and technical problems. Due to the uncontrolled pre-post design we cannot exclude external influences on the results. Nevertheless, the intervention was able to improve measured quality of care. Barriers were detected that should be considered in a possible implementation of quality control programs.

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Detection of Chronic Obstructive Pulmonary Disease in Primary Care in Salzburg, Austria: Findings from the Real World

Cited by 19 publications

References 34 publications

Impact of Airflow Limitation on Carotid Atherosclerosis in Coronary Artery Disease Patients

Impact of Airflow Limitation on Carotid Atherosclerosis in Coronary Artery Disease Patients

Development and validation of the Salzburg COPD-screening questionnaire (SCSQ): a questionnaire development and validation study

Improving quality of care in general practices by self-audit, benchmarking and quality circles

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