Guideline Adherence in Outpatient Clinics for Chronic Obstructive Pulmonary Disease: Results from a Clinical Audit

Abstract

ObjectivesPrevious clinical audits of COPD have provided relevant information about medical intervention in exacerbation admissions. The present study aims to evaluate adherence to current guidelines in COPD through a clinical audit.MethodsThis is a pilot clinical audit performed in hospital outpatient respiratory clinics in Andalusia, Spain (eight provinces with more than 8 million inhabitants), including 9 centers (20% of the public centers in the area) between 2013 and 2014. Cases with an established diagnosis of COPD based on risk factors, clinical symptoms, and a post-bronchodilator FEV1/FVC ratio of less than 0.70 were deemed eligible. The performance of the outpatient clinics was benchmarked against three guidance documents available at the time of the audit. The appropriateness of the performance was categorized as excellent (>80%), good (60−80%), adequate (40−59%), inadequate (20−39%), and highly inadequate (<20%).ResultsDuring the audit, 621 clinical records were audited. Adherence to the different guidelines presented a considerable variability among the different participating hospitals, with an excellent or good adherence for symptom recording, MRC or CAT use, smoking status evaluation, spirometry, or bronchodilation therapy. The most outstanding areas for improvement were the use of the BODE index, the monitoring of treatments, the determination of alpha1-antitrypsin, the performance of exercise testing, and vaccination recommendations.ConclusionsThe present study reflects the situation of clinical care for COPD patients in specialized secondary care outpatient clinics. Adherence to clinical guidelines shows considerable variability in outpatient clinics managing COPD patients, and some aspects of the clinical care can clearly be improved.

PTEN/PI3k/AKT Regulates Macrophage Polarization in Emphysematous mice

“…Ochs M. suggested that quantitative assessment of microstructure was the only way to reliably demonstrate the presence of emphysematous alterations [29]. According to the American Thoracic Society, emphysema is defined as 'abnormal, permanent enlargement of the airspaces distal to the terminal bronchiole, accompanied by destruction of their walls' [30]. This widely accepted definition was fulfilled in our experiments that combined CS exposure with intraperitoneal injection of CSE to induce emphysema.…”

Seasonal variability in clinical care of COPD outpatients: results from the Andalusian COPD audit

“…The analysis of clinical performance against the recommended care has provided relevant information on how care is provided to COPD patients 16. Clinical audits are conceived as a tool to summarize the clinical performance of health care over a specified period of time and are aimed at providing information to health care professionals to allow them to assess and adjust their performance 17.…”

“…Clinical audits are conceived as a tool to summarize the clinical performance of health care over a specified period of time and are aimed at providing information to health care professionals to allow them to assess and adjust their performance 17. Although clinical performance has been extensively studied during COPD admissions,18,19 the situation in outpatient clinics has been mainly evaluated in the Andalusian COPD audit,12 providing information on clinicians’ adherence to guidelines16 and pharmacological treatment performance 20. Previous studies have evaluated the rates of adherence to GOLD guidelines for COPD treatment among pulmonologists; however, these studies focus exclusively on pharmacological treatments 21–23.…”

Audit of the quality of medical care as a way to improve the efficiency of medical organizations

“…В серии аудитов была отмечена положительная динамика, во многих аспектах клинические рекомендации выполнялись превосходно, однако был выявлен ряд проблем, потребовавший не только коррекции работы медицинских организаций, но и пересмотра клинических рекомендаций [25].…”