Implementation of an Integrated Care Model for Frequent-Exacerbator COPD Patients: A Controlled Prospective Study

Cosío, Borja G.; Shafiek, Hanaa; Verdú, Javier; Fiorentino, Federico; Valera, José Luis; Martínez, Rocio; Romero, Sara; Ramón, Lluisa; Toledo-Pons, Núria; Sala, Ernest

doi:10.1016/j.arbres.2021.01.025

Cited by 11 publications

(9 citation statements)

References 32 publications

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“…13 The study was conducted in a tertiary teaching hospital between 2012 and 2020. All patients were regularly followed up after discharged in ordinary outpatient respiratory clinics or through an integrated care programme for ExCOPD running in the same hospital 10 for a maximum of 8 years. All the patients signed a written informed consent.…”

Section: Study Design and Ethicsmentioning

confidence: 99%

“…6 7 PsA isolation during AECOPD hospitalisations is associated with greater degree of airway obstruction, use of systemic corticosteroids, poorer lung function, previous isolation of PsA and previous hospital admission. [8][9][10] Further, PsA has been linked to increased airway inflammation in patients with COPD 11 and mortality. 12 Inhaled corticosteroids (ICS) are indicated in the treatment of ExCOPD, especially if blood eosinophil count (BEC) are higher than 300 cells/µL 13 14 ; however, ICS therapy is associated with various adverse effects especially the risk of pneumonia 15 which raises the debate about the prescription of ICS in patients with infectious exacerbations.…”

Section: Introductionmentioning

confidence: 99%

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Inhaled corticosteroid dose is associated withPseudomonas aeruginosainfection in severe COPD

et al. 2021

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IntroductionPatients with chronic obstructive pulmonary disease (COPD) with frequent exacerbations (ExCOPD) are commonly treated with inhaled corticosteroids (ICS) and are at risk of infections caused by potential pathogenic bacteria (PPB) including Pseudomonas aeruginosa (PsA).ObjectivesTo investigate the association between the use of ICS and PsA infection among ExCOPD.MethodsCase–control study with longitudinal follow-up that recruited ExCOPD after a hospitalisation due to exacerbation between 2012 and 2020. Patients with isolation of PsA (COPD-PsA) in sputum either during admission or follow-up were compared with those with other or no PPB. Clinical, functional characteristics, DDD, use of ICS and survival were evaluated. Cox regression analysis was performed to evaluate the risk factors associated to PsA infection and mortality.Results358 patients (78% male, mean age 73±9 years) were enrolled and followed up for a median of 4 years (IQR=3–8). 173 patients (48.3%) had at least a positive culture for PsA. COPD-PsA had more frequent exacerbations, more severe airflow limitation and higher mortality (69.4% vs 46.5%, p<0.001). There were no differences in the use of ICS between groups but the dose of ICS was significantly higher among COPD-PsA (median of 500 µg fluticasone propionate equivalents (IQR=250–1000) vs 400 µg (IQR=200–1000), p=0.007). Blood eosinophil count (BEC) was not different between ICS users and non-users. In multivariate analysis, the dose of ICS was an independent risk factor for PsA infection and mortality but not ICS use.ConclusionsICS dose, but not its use, could be a risk factor for PsA infection in patients with severe COPD regardless of BEC.

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Section: Study Design and Ethicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Inhaled corticosteroid dose is associated withPseudomonas aeruginosainfection in severe COPD

et al. 2021

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“…[19][20][21][22][23][24][25][26] Programs focused on integrated care and disease management have shown beneficial patient outcomes, reporting improvements in patient quality of life and hospitalization rates for exacerbations. [26][27][28][29] However, overall results of previous QIPs on COPD exacerbations of different severities have been mixed, and a long-term reduction of exacerbations has not been consistently demonstrated. [30][31][32][33] This may have been due to the short-term nature of some of the initiatives, which did not involve long-term monitoring or evaluation of improvement in patient clinical outcomes.…”

Section: Quality Improvement Programs In Copdmentioning

confidence: 99%

CONQUEST: A Quality Improvement Program for Defining and Optimizing Standards of Care for Modifiable High-Risk COPD Patients

Alves¹,

Pullen²,

Hurst³

et al. 2022

PROM

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The COllaboration on QUality improvement initiative for achieving Excellence in STandards of COPD care (CONQUEST) aims to improve the quality of COPD care in primary care. The CONQUEST target population includes patients diagnosed with COPD, and those undiagnosed but with COPD-like exacerbations, who are at high but modifiable risk of COPD exacerbations, increased morbidity, and mortality. Timely diagnosis and optimized management to reduce these risks is vital. There is a need for a quality improvement program (QIP) that enables long-term improvement of patient clinical outcomes via integration of the program into routine clinical care. Core to the CONQUEST program is the adoption of four specifically designed, globally applicable, and expert-agreed quality standards (QS) for modifiable high-risk COPD patients. Translation of the QS into clinical practice, and implementation of the QIP, is guided by the CONQUEST global operational protocol provided to sites meeting the minimum healthcare system requirements. Initial analyses of current practices are conducted to generate baseline assessments of need within healthcare systems and sites looking to implement the QIP. Implementation is supported by the provision of CONQUEST resources and tools, such as clinical decision support, that promote prompt identification and treatment of patients. Utilization of electronic medical record (EMR) and patient-reported data are integral components of the QIP. Regular, automated collection and analysis of data, combined with a cyclical review of the implementation process, will be conducted for long-term, continuous improvement and health impact evaluation. The CONQUEST QIP will be an important resource in the identification and management of patients with modifiable high-risk COPD. Embedding the CONQUEST QS into routine clinical practice with regular evaluation and feedback will result in long-term quality of care improvement.

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“…Although there is no consensus on the characteristics of those patients who might benefit from different levels of care 36 , in general, stable patients with bronchiectasis can be managed in Primary Care. However, joint management with specialized units is recommended for patients with chronic bronchial infection by pathogenic microorganisms (particularly when associated with comorbidities with severe asthma and COPD) 36 , 37 , a lack of clinical stability, aetiologies that are difficult to manage 22 , 33 or frequent exacerbations. Some practical advice for the management of patients with bronchiectasis in Primary Care could be as follows: It seems obvious that some general management points concur with those applicable to other chronic airway diseases: good education about the disease and about inhalation techniques; adequate vaccination against influenza, SARS-CoV-2 and Streptococcus pneumoniae ; cessation of smoking; regular clinical visits; promotion of good health-related and dietary habits; and smooth coordination with the secondary/specialist centre if the patient needs to be referred 22 , 35 , 38 .…”

Section: Therapeutic Aspectsmentioning

confidence: 99%

Practical tips in bronchiectasis for Primary Care

Martínez-García

García-Ortega

Oscullo

2022

npj Prim. Care Respir. Med.

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Bronchiectasis is the third most common chronic inflammatory airway disease, after chronic obstructive pulmonary disease (COPD) and asthma with a prevalence clearly underestimated probably because of its clinical similitudes with other chronic airway diseases. Bronchiectasis can be caused by a dozen of pulmonary and extra-pulmonary diseases and a variable number and severity of exacerbations can appear throughout its natural history, usually with an infectious profile. The dilation of the airway and the inflammation/infection is their radiological and pathophysiological hallmarks. Primary Care should play an important play in many aspects of the bronchiectasis assessment. In this article, we will try to offer a series of important concepts and practical tips on some key aspects of the diagnosis and management of bronchiectasis in Primary Care: clinical suspicion, diagnostic methods, severity assessment, overlap with asthma and COPD and microbiological and therapeutic aspects.

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Implementation of an Integrated Care Model for Frequent-Exacerbator COPD Patients: A Controlled Prospective Study

Cited by 11 publications

References 32 publications

Inhaled corticosteroid dose is associated withPseudomonas aeruginosainfection in severe COPD

Inhaled corticosteroid dose is associated withPseudomonas aeruginosainfection in severe COPD

CONQUEST: A Quality Improvement Program for Defining and Optimizing Standards of Care for Modifiable High-Risk COPD Patients

Practical tips in bronchiectasis for Primary Care

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