Atención médica según el nivel de riesgo y su adecuación a las recomendaciones de la guía española de la enfermedad pulmonar obstructiva crónica (EPOC) (GesEPOC): Estudio EPOCONSUL

Rubio, Myriam Calle; Hermosa, Juan Luis Rodríguez; Soler-Cataluña, Juan José; Lόpez-Campos, José Luís; Navarrete, Bernardino Alcázar; Soriano, Joan B.; González-Moro, José Miguel Rodríguez; Fuentes‐Ferrer, Manuel; Miravitlles, Marc

doi:10.1016/j.arbres.2017.11.015

Cited by 37 publications

(10 citation statements)

References 33 publications

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“…These findings are in line with numerous studies that have shown that the presence of comorbidities, cough with chronic expectoration and emphysema are associated with a higher risk of exacerbations, a worse prognosis and higher mortality [32, 33]. In both general outpatient respiratory clinics and those specialized in COPD, the majority of COPD patients were classified as high risk according to the GesEPOC criteria (post-bronchodilator FEV1%, degree of dyspnea and history of exacerbations) described in S2 Table [13, 34], although it must be noted that patients who met the three criteria defining high risk with a higher degree of dyspnea and obstruction severity were more common at specialized clinics. These differential aspects in the clinical characteristics of patients and the origin of the visit could suggest that, at centers with both types of clinics, patients who are more complex or “fragile” or the patients who need complex treatment (home ventilation or respiratory rehabilitation) are strategically selected for referral to the specialized COPD outpatient respiratory clinics from other specialties rather than the general outpatient respiratory clinic to which patients are generally referred from primary care.…”

Section: Discussionsupporting

confidence: 67%

Assessing the clinical practice in specialized outpatient clinics for chronic obstructive pulmonary disease: Analysis of the EPOCONSUL clinical audit

et al. 2019

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BackgroundChronic 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.MethodsEPOCONSUL 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.ResultsOnly 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.ConclusionA 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.

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Section: Discussionsupporting

confidence: 67%

Assessing the clinical practice in specialized outpatient clinics for chronic obstructive pulmonary disease: Analysis of the EPOCONSUL clinical audit

et al. 2019

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“…7,8 The Spanish COPD Guidelines (GesEPOC) also recommend triple therapy with LAMA/LABA/ICS for high-risk patients who do not present good control of exacerbations with two drugs (either two long-acting bronchodilators or a long-acting bronchodilator + ICS). [9][10][11] Poor adherence to treatment is estimated to contribute to nearly 200,000 premature deaths in Europe per year. 12 Patients with chronic conditions such as hypertension, diabetes or COPD are particularly vulnerable to poor health outcomes if they do not adhere to their medications.…”

Section: Introductionmentioning

confidence: 99%

<p>Estimation of the Clinical and Economic Impact of an Improvement in Adherence Based on the Use of Once-Daily Single-Inhaler Triple Therapy in Patients with COPD</p>

Miravitlles¹,

Marín²,

Huerta³

et al. 2020

COPD

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Background: Adherence to treatment is key to achieve desired outcomes. In COPD, adherence is generally suboptimal and is impaired by treatment complexity. Objective: To estimate the clinical and economic impact of an improvement in treatment adherence due to an increased use of once-daily single-inhaler triple therapy (SITT) in patients with COPD. Patients and Methods: A 7-state Markov model with monthly cycles was developed. Patients with moderate-to-very severe COPD, for whom triple therapy is indicated, were included. Outcomes and costs were estimated and compared for two scenarios: current distribution of adherent patients treated with multiple inhaler triple therapies (MITT) vs a potential scenario where patients shifted to once-daily SITT. In the potential scenario, adherence improvement due to once-daily SITT attributes was estimated. Costing was based on the Spanish National Health System (NHS) perspective (€2019). A 3-year time horizon was defined considering a 3% discount rate for both costs and outcomes. Results: A target population of 185,111 patients with moderate-to-very severe COPD currently treated with MITT was estimated. A 20% increase in the use of once-daily SITT in the potential scenario raised adherence up to 52%. This resulted in 6835 exacerbations and 532 deaths avoided, with 775 LYs and 594 QALYs gained. Total savings reached €7,082,105. Exacerbation reduction accounted for 61.8% (€4,378,201) of savings. Conclusion: Increasing the use of once-daily SITT in patients with moderate-to-very severe COPD treated with triple therapy would be associated with an improvement in adherence, a reduction of exacerbations and deaths, and cost savings for the Spanish NHS.

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“…[1][2][3] The correct assessment of COPD exacerbations will be decisive in evaluating the risk, 1,2 degree of clinical control in COPD 4 and to plan therapeutic interventions. 5 Some individuals appear more susceptible to developing exacerbations and are termed frequent exacerbators or COPD exacerbator phenotype. 6,7 In these patients, correctly identifying exacerbations will be very important as this group has a higher risk of morbidity and mortality 8 since they have a higher risk of hospitalization and are able to benefit from more specific therapies and action plans in order to help prevent exacerbations and improve their quality of life.…”

Section: Introductionmentioning

confidence: 99%

Assessing the Usefulness of the Prevexair Smartphone Application in the Follow-Up High-Risk Patients with COPD

Hermosa¹,

Gomila²,

Diago³

et al. 2021

COPD

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Atención médica según el nivel de riesgo y su adecuación a las recomendaciones de la guía española de la enfermedad pulmonar obstructiva crónica (EPOC) (GesEPOC): Estudio EPOCONSUL

Cited by 37 publications

References 33 publications

Assessing the clinical practice in specialized outpatient clinics for chronic obstructive pulmonary disease: Analysis of the EPOCONSUL clinical audit

Assessing the clinical practice in specialized outpatient clinics for chronic obstructive pulmonary disease: Analysis of the EPOCONSUL clinical audit

<p>Estimation of the Clinical and Economic Impact of an Improvement in Adherence Based on the Use of Once-Daily Single-Inhaler Triple Therapy in Patients with COPD</p>

Assessing the Usefulness of the Prevexair Smartphone Application in the Follow-Up High-Risk Patients with COPD

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