Determinants of medical prescriptions for COPD care: an analysis of the EPOCONSUL clinical audit
Por:
Lopez-Campos JL, Navarrete BA, Soriano JB, Soler-Cataluña JJ, González-Moro JMR, Ferrer MEF and Rubio MC
Publicada:
1 ene 2018
Ahead of Print:
27 jul 2018
Resumen:
Purpose: Current COPD management recommendations indicate that pharmacological treatment can be stepped up or down, but there are no recommendations on how to make this adjustment. We aimed to describe pharmacological prescriptions during a routine clinical visit for COPD and study the determinants of changing therapy.
Methods: EPOCONSUL is a Spanish nationwide observational cross-sectional clinical audit with prospective case recruitment including 4,508 COPD patients from outpatient respiratory clinics for a period of 12 months (May 2014 May 2015). Prescription patterns were examined in 4,448 cases and changes analyzed in stepwise backward, binomial, multivariate, logistic regression models.
Results: Patterns of prescription of inhaled therapy groups were no treatment prescribed, 124 (2.8%) cases; one or two long-acting bronchodilators (LABDs) alone, 1,502 (34.6%) cases; LABD with inhaled corticosteroids (ICSs), 389 (8.6%) cases; and triple therapy cases, 2,428 (53.9%) cases. Incorrect prescriptions of inhaled therapies were observed in 261 (5.9%) cases. After the clinical visit was audited, 3,494 (77.5%) cases did not modify their therapeutic prescription, 307 (6.8%) cases had a step up, 238 (5.3%) cases had a change for a similar scheme, 182 (4.1%) cases had a step down, and 227 (5.1%) cases had other non-specified change. Stepping-up strategies were associated with clinical presentation (chronic bronchitis, asthma-like symptoms, and exacerbations), a positive bronchodilator test, and specific inhaled medication groups. Stepping down was associated with lung function impairment, ICS containing regimens, and nonexacerbator phenotype.
Conclusion: The EPOCONSUL study shows a comprehensive evaluation of pharmacological treatments in COPD care, highlighting strengths and weaknesses, to help us understand how physicians use available drugs.
Filiaciones:
Lopez-Campos JL:
Medical-Surgical Unit of Respiratory Diseases, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain,
CIBER of Respiratory Diseases, Instituto de Salud Carlos III, Madrid, Spain,
Navarrete BA:
Pneumology Department, Hospital de Alta Resolución de Loja, Granada, Spain
Soriano JB:
Research Institute, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain
:
Pneumology Department, Hospital de Arnau de Villanova-Lliria, Valencia, Spain
González-Moro JMR:
Pneumology Department, Hospital Universitario Príncipe de Asturias, Madrid, Spain
Ferrer MEF:
Department of Medicine, Faculty of Medicine, University Complutense of Madrid, Madrid, Spain
Research Unit, Instituto de Investigación del Hospital Clínico San Carlos, Madrid, Spain
Clinical Management Unit, Preventive Medicine and Research Institute of Hospital Clínico San Carlos, Madrid, Spain
Rubio MC:
Department of Medicine, Faculty of Medicine, University Complutense of Madrid, Madrid, Spain
Research Unit, Instituto de Investigación del Hospital Clínico San Carlos, Madrid, Spain
Pneumology Department, Hospital Clínico San Carlos, Madrid, Spain
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