Variability in adherence to clinical practice guidelines and recommendations in COPD outpatients: a multi-level, cross-sectional analysis of the EPOCONSUL study
Por:
Calle Rubio M, Lopez-Campos JL, Soler-Cataluna JJ, Alcazar Navarrete B, Soriano JB, Rodriguez Gonzalez-Moro JM, Fuentes Ferrer ME, Rodriguez Hermosa JL and EPOCONSUL Study
Publicada:
2 dic 2017
Categoría:
Pulmonary and respiratory medicine
Resumen:
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.
Filiaciones:
Calle Rubio M:
Pulmonary Department, Research Institute of Hospital Clinico San Carlos (IdISSC), Faculty of Medicine, University Complutense of Madrid, C/ Martin Lagos s/n, 28040, Madrid, Spain.
Lopez-Campos JL:
Unidad Medico-Quirurgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocio/Universidad of Sevilla, Sevilla, Spain
CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
:
Pulmonary Department, Hospital of Arnau de Villanova, Valencia, Spain
Alcazar Navarrete B:
Pulmonary Department, Hospital of Alta Resolucion de Loja, Granada, Spain
Soriano JB:
Research Institute of Hospital University La Princesa (IISP), University Autonoma of Madrid, Madrid, Spain
Rodriguez Gonzalez-Moro JM:
Pulmonary Department, H. Universitario Principe de Asturias, Alcala de Henares, Madrid, Spain
Fuentes Ferrer ME:
UGC de Medicina Preventiva, Research Institute of Hospital Clinico San Carlos (IdISSC), Hospital Clinico San Carlos, Faculty of Medicine, University Complutense of Madrid, Madrid, Spain
Rodriguez Hermosa JL:
Pulmonary Department, Research Institute of Hospital Clinico San Carlos (IdISSC), Faculty of Medicine, University Complutense of Madrid, C/ Martin Lagos s/n, 28040, Madrid, Spain
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