Fiabilidad del diagnóstico de la EPOC en atención primaria y neumología en España. Factores predictivos

Miguel-Díez, Javier de; Alonso, José Luís Izquierdo; París, Jesús Molina; González-Moro, JM Rodríguez; Ramos, Pilar; Alonso-Vega, G. Gaspar

doi:10.1157/13047333

Cited by 35 publications

(12 citation statements)

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“…This observational, descriptive, cross-sectional and multicenter study enrolled a stratified sample from each autonomous Spanish community from the practices of primary care and outpatient clinics of pneumology in secondary and tertiary care hospitals (11).…”

Section: Methodsmentioning

confidence: 99%

Economic Impact of Pulmonary Drugs on Direct Costs of Stable Chronic Obstructive Pulmonary Disease

Alonso

Miguel-Díez

2004

COPD: Journal of Chronic Obstructive Pulmonary Disease

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Annual direct costs were 1,657 EUR in stage I, 2,425 EUR in stage II, and 3,303 EUR in stage III. The mean direct costs was 2,061 EUR (38% corresponded to drug therapy). Medication accounted for 43%, 37.6%, and 28.4% of total direct costs for stage I, II, and III, respectively. Inhaled steroids and long-acting beta2-agonists accounted for 78%, 76%, and 75% of total drugs costs in stages I, II, and III, respectively. Drug therapy which was not in accordance with guidelines accounted for 78.7% and 54% of total drug costs in stages I and II, respectively. Most patients with severe disease were treated adequately. ANSWER TO THE QUESTION: Pharmacologic treatment has a great impact on direct medical costs in stable COPD. According to GOLD guidelines, patients with mild or moderate COPD are frequently treated with nonrecommended drugs.

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Section: Methodsmentioning

confidence: 99%

Economic Impact of Pulmonary Drugs on Direct Costs of Stable Chronic Obstructive Pulmonary Disease

Alonso

Miguel-Díez

2004

COPD: Journal of Chronic Obstructive Pulmonary Disease

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“…Recent studies indicate that only between 38 and 45% of patients at high risk have had a diagnostic spirometric analysis performed by the clinician in the PCC [20,24-26]. The most frequent explanations for this low percentage are: the lack of awareness of the impact of the test, unfamiliarity, lack of training, shortage of personnel and time, and the difficulty in interpreting the test [26,50,51]. European studies such as that by Rutschmann et al have shown that 82% of the clinicians in PC consider spirometry as the most appropriate method for the diagnosis of COPD while only 55% of them explicitly use the test and only 33% know the correct GOLD diagnostic criteria [14].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a combined strategy directed towards health-care professionals and patients with chronic obstructive pulmonary disease (COPD): Information and health education feedback for improving clinical monitoring and quality-of-life

Valero¹,

Monteagudo

Llagostera

et al. 2009

BMC Public Health

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BackgroundChronic obstructive pulmonary disease (COPD) is a health problem that is becoming increasingly attended-to in Primary Care (PC). However, there is a scarcity of health-care programs and studies exploring the implementation of Clinical Practice Guidelines (CPG). The principal objective of the present study is to evaluate the effectiveness of a combined strategy directed towards health-care professionals and patients to improve the grade of clinical control and the quality-of-life (QoL) of the patients via a feedback on their state-of-health. A training plan for the health-care professionals is based on CPG and health education.Method/DesignMulti-centred, before-after, quasi experimental, prospective study involving an intervention group and a control group of individuals followed-up for 12 months. The patients receive attention from urban and semi-urban Primary Care Centres (PCC) within the administrative area of the Costa de Ponent (near Barcelona). All the pacients corresponding to the PCC of one sub-area were assigned to the intervention group and patients from the rest of sub-areas to the group control. The intervention includes providing data to the health-care professionals (clinician/nurse) derived from a clinical history and an interview. A course of training focused on aspects of CPG, motivational interview and health education (tobacco, inhalers, diet, physical exercise, physiotherapy). The sample random includes a total of 801 patients (≥ 40 years of age), recorded as having COPD, receiving attention in the PCC or at home, who have had at least one clinical visit, and who provided written informed consent to participation in the study. Data collected include socio-demographic characteristics, drug treatment, exacerbations and hospital admissions, evaluation of inhaler use, tobacco consumption and life-style and health-care resources consumed. The main endpoints are dyspnoea, according to the modified scale of the Medical Research Council (MRC) and the QoL, evaluated with the St George's Respiratory Questionnaire (SGRQ). The variables are obtained at the start and the end of the intervention. Information from follow-up visits focuses on the changes in life-style activities of the patient.DiscussionThis study is conducted with the objective of generating evidence that shows that implementation of awareness programs directed towards health-care professionals as well as patients in the context of PC can produce an increase in the QoL and a decrease in the disease exacerbation, compared to standard clinical practice.Trial RegistrationClinical Trials.gov Identifier: NCT00922545;

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“…Por otro lado, es el propio médico en muchas ocasiones el que no hace un diagnóstico certero, al no realizar las pruebas funcionales requeridas para objetivar la obstrucción persistente al flujo aéreo y cuantificar su grado. Recordemos que sólo el 49,1% de los centros de atención primaria disponen de un espirómetro y de ellos sólo el 22,1% dispone de algún tipo de control de calidad periódico que certifique su fiabilidad (16). Pero independientemente de que se encuentren disponibles o no las pruebas complementarias necesarias, no existe una concienciación sistemá-tica de búsqueda de obstrucción al flujo aéreo entre fumadores (17).…”

Section: Chronic Obstructive Pulmonary Disease (Copd) Is a Very Commounclassified

¿Definimos correctamente la EPOC?

Cid

Barcala

Reino

et al. 2008

An. Med. Interna (Madrid)

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INTRODUCCIÓNEl primer intento de definir y darle categoría a la EPOC es en 1958 en el Simposio Ciba en el que se introduce el concepto de enfermedad pulmonar crónica no específica, en el cual se incluye la bronquitis crónica y la enfermedad obstructiva generalizada, que a su vez engloba el asma y el enfisema (1). En 1965 la bronquitis crónica se subdivide en simple y obstructiva. Y es en el año 1975, bajo el padrinazgo de la American Thoracic Society y el American College of Chest Physicians, cuando surge por primera vez el acrónimo COPD, como una enfermedad de etiología incierta caracterizada por un persistente enlentecimiento al flujo aéreo durante la espiración forzada (2). Posteriormente también contó con una amplia difusión el término introducido por Thurlberck como obstrucción crónica al flujo aéreo (OCFA) (3). En el año 1987 la American Thoracic Society establece una definición morfológica y funcional de la EPOC como una alteración caracterizada por una disminución de los flujos aéreos espiratorios que no se modifican durante varios meses de observación y que está producida como consecuencia de alteraciones estructurales que afectan a las vías aéreas y al parénquima pulmonar, y que incluye la bronquitis crónica, el enfisema y la enfermedad de la vía aérea pequeña (4).La enfermedad pulmonar obstructiva crónica (EPOC) es un proceso caracterizado por la presencia de una obstrucción crónica, progresiva y poco reversible al flujo aéreo, causado principalmente por una respuesta inflamatoria anómala frente al humo del tabaco (5).Si hacemos algunas puntualizaciones a este respecto, diremos que dicho término surge para diferenciar este proceso de otras patologías que aunque cursan con reducción del flujo aéreo tienen una causa específica, como ocurre con la estenosis de la vía aérea superior, la fibrosis quística, las bronquiectasias, o la bronquiolitis obliterante. También lo diferencia de otros procesos como el asma bronquial, por su carácter rever- [0212-7199 (2008) RESUMENLa Enfermedad Pulmonar Obstructiva Crónica (EPOC) es una enfermedad muy frecuente, cuya prevalencia sigue aumentando y que en un futuro próximo supondrá un problema socio-sanitario. El propósito de este artículo es hacer una reflexión sobre el concepto EPOC, para contribuir por parte de los médicos a su divulgación a la población y muy concretamente al abandono del hábito tabáquico. Por otro lado también queremos hacer constar, que debido a los avances en el conocimiento etiológico, fisiopatológico, técnicas de imagen etc, el término se ha perfilado de forma muy positiva. No obstante creemos que el acrónimo todavía incluye entidades con perfiles muy diferentes. Esperemos que en el futuro, estableciendo distintos fenotipos y sobre todo con ayuda de la biología molecular podamos clarificar más este concepto.

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Fiabilidad del diagnóstico de la EPOC en atención primaria y neumología en España. Factores predictivos

Cited by 35 publications

References 0 publications

Economic Impact of Pulmonary Drugs on Direct Costs of Stable Chronic Obstructive Pulmonary Disease

Economic Impact of Pulmonary Drugs on Direct Costs of Stable Chronic Obstructive Pulmonary Disease

Evaluation of a combined strategy directed towards health-care professionals and patients with chronic obstructive pulmonary disease (COPD): Information and health education feedback for improving clinical monitoring and quality-of-life

¿Definimos correctamente la EPOC?

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