Improvement in the management of chronic obstructive pulmonary disease following a clinical educational program: results from a prospective cohort study in the Sicilian general practice setting

Abstract

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disorder of the lungs associated with progressive disability. Although general practitioners (GPs) should play an important role in the COPD management, critical issues have been documented in the primary care setting. The aim of this study was to evaluate the effectiveness of an educational program for the improvement of the COPD management in a Sicilian general practice setting. The effectiveness of the program, was evaluated by comparing 15 quality-of-care indicators developed from data extracted by 33 GPs, at baseline vs. 12 and 24 months, and compared with data from a national primary care database (HSD). Moreover, data on COPD-related and all-cause hospitalizations over time of COPD patients, was measured. Overall, 1,465 patients (3.2%) had a registered diagnosis of COPD at baseline vs. 1,395 (3.0%) and 1,388 (3.0%) over time (vs. 3.0% in HSD). COPD patients with one spirometry registered increased from 59.7% at baseline to 73.0% after 2 years (vs. 64.8% in HSD). Instead, some quality of care indicators where not modified such as proportion of COPD patients treated with ICS in monotherapy that was almost stable during the study period: 9.6% (baseline) vs. 9.9% (after 2 years), vs. 7.7% in HSD. COPD-related and all-cause hospitalizations of patients affected by COPD decreased during the two observation years (from 6.9% vs. 4.0%; from 23.0% vs. 18.9%, respectively). Our study showed that educational program involving specialists, clinical pharmacologists and GPs based on training events and clinical audit may contribute to partly improve both diagnostic and therapeutic management of COPD in primary care setting, despite this effect may vary across GPs and indicators of COPD quality of care.

Planned primary health care asthma contacts during 12-year follow-up after Finnish National Asthma Programme: focus on spirometry

“…Evidence-based medicine and guidelines have improved the quality of health care, but still suboptimal adherence to care guidelines is a common worldwide problem seen not only with asthma 2-5 and chronic obstructive pulmonary disease [52][53][54] but also with other common chronic conditions, such as cardiovascular diseases and diabetes [55][56][57][58][59] . GPs generally deal with multimorbid patients.…”

<p>Compliance of Pharmacotherapy with GOLD Guidelines: A Longitudinal Study in Patients with COPD</p>

“…25 Educational interventions to improve physician's familiarity with guidelines have been shown to be successful; thus, their utilisation should be further promoted. 25,26 In this study, ICS over-prescription was the most common reason for guideline non-compliance. This finding is quite alarming, as serious side-effects of ICS, such as pneumonia, could be avoided.…”

Hospital Care of Older Patients With COPD: Adherence to International Guidelines for Use of Inhaled Bronchodilators and Corticosteroids

“…On the basis of our data and currently available evidence, we believe that interventional educational programs are needed and likely to have a positive role in improving physicians' adherence to guideline recommendations. 21 Furthermore, specific education interventions can also improve patient adherence to physicians' prescription. 16 This study has limitations.…”