Assessing the clinical practice in specialized outpatient clinics for chronic obstructive pulmonary disease: Analysis of the EPOCONSUL clinical audit
Por:
Calle Rubio M, Soler-Cataluña JJ, López-Campos JL, Alcázar Navarrete B, Rodríguez González-Moro JM, Soriano JB, Fuentes Ferrer ME and Rodriguez Hermosa JL
Publicada:
6 feb 2019
Ahead of Print:
6 feb 2019
Categoría:
Multidisciplinary
Resumen:
Background
Chronic obstructive pulmonary disease (COPD) is one of the main reasons for healthcare appointments and use of healthcare resources. In recent years, clinics specializing in COPD have been developed to offer improved care and optimization of recourses for patients with high complexity and frequent decompensations. However, little is known about the clinical practice in this clinical model specializing in COPD. The objectives of this study were to assess the prevalence, characteristics of specialized COPD outpatient respiratory clinics and to evaluate clinical practice in this healthcare model.
Methods
EPOCONSUL is a Spanish nationwide, observational, cross-sectional, clinical audit with prospective case recruitment including the clinical records for 4508 COPD cases from outpatient respiratory clinics over a 12-month period (May 2014-May 2015). The study evaluated clinical practice in 2378 cases from 28 hospitals with both general and specialized COPD outpatient respiratory clinics.
Results
Only 28 (47.5%) centers had an outpatient clinic specializing in COPD, which was characterized by longer patient visits and a higher prevalence of written protocols compared to a general clinic. Patients treated in a specialized clinic had greater obstruction severity, a higher degree of dyspnea and also suffered from more comorbidities. The majority of patients at both types of clinic were classified as high risk (81.1% versus 83%, p = 0.384) according to GesEPOC criteria. Clinical control of COPD was more frequent at specialized clinics, with significant differences in non-severe patients (70.5% versus 56.1%, p < 0.001). Testing was done more frequently in specialized clinics, with better adherence to good clinical practice recommendations.
Conclusion
A specialized COPD outpatient clinic is a healthcare model found in few pulmonology departments that treats more severe patients and those with increased comorbidities. The COPD patients treated in a specialized clinic had a better clinical control, as defined by impact and clinical stability. It is a healthcare model to offer improved care with a higher degree of adherence to guidelines.
Filiaciones:
Calle Rubio M:
Pulmonology Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
Medical Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
:
Pulmonology Department, H. de Arnau de Villanova, Valencia, Spain
López-Campos JL:
Respiratory Disease Medical-Surgical Unit. 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
Alcázar Navarrete B:
Pulmonology Department, Hospital de Alta Resolución de Loja, Granada, Spain
Rodríguez González-Moro JM:
Pulmonology Department, H. Universitario Principe de Asturias, Alcalá de Henares, Madrid, Spain
Soriano JB:
Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain
Fuentes Ferrer ME:
Medical Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
Preventative Medicine CMU, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
Rodriguez Hermosa JL:
Pulmonology Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
Medical Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
Green Published, gold, Green Submitted
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