Determinants of medical prescriptions for COPD care: an analysis of the EPOCONSUL clinical audit

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...

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Autores: Lopez-Campos JL, Navarrete BA, Soriano JB, Soler-Cataluña JJ, González-Moro JMR, Ferrer MEF, Rubio MC
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2018
País:España
Institución:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
Repositorio:r-FISABIO. Repositorio Institucional de Producción Científica
OAI Identifier:oai:fisabio.fundanetsuite.com:p3749
Acceso en línea:https://fisabio.portalinvestigacion.com/publicaciones/3749
Access Level:acceso abierto
Palabra clave:COPD
clinical audit
pharmacological prescriptions
quality of care
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spelling Determinants of medical prescriptions for COPD care: an analysis of the EPOCONSUL clinical auditLopez-Campos JLNavarrete BASoriano JBSoler-Cataluña JJGonzález-Moro JMRFerrer MEFRubio MCCOPDclinical auditpharmacological prescriptionsquality of carePurpose: 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.DOVE MEDICAL PRESS LTD2018info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://fisabio.portalinvestigacion.com/publicaciones/3749International Journal of Chronic Obstructive Pulmonary DiseaseISSN: 11782005ISSNl: 11769106reponame:r-FISABIO. Repositorio Institucional de Producción Científicainstname:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)Inglésinfo:eu-repo/semantics/openAccessoai:fisabio.fundanetsuite.com:p37492026-06-11T12:45:17Z
dc.title.none.fl_str_mv Determinants of medical prescriptions for COPD care: an analysis of the EPOCONSUL clinical audit
title Determinants of medical prescriptions for COPD care: an analysis of the EPOCONSUL clinical audit
spellingShingle Determinants of medical prescriptions for COPD care: an analysis of the EPOCONSUL clinical audit
Lopez-Campos JL
COPD
clinical audit
pharmacological prescriptions
quality of care
title_short Determinants of medical prescriptions for COPD care: an analysis of the EPOCONSUL clinical audit
title_full Determinants of medical prescriptions for COPD care: an analysis of the EPOCONSUL clinical audit
title_fullStr Determinants of medical prescriptions for COPD care: an analysis of the EPOCONSUL clinical audit
title_full_unstemmed Determinants of medical prescriptions for COPD care: an analysis of the EPOCONSUL clinical audit
title_sort Determinants of medical prescriptions for COPD care: an analysis of the EPOCONSUL clinical audit
dc.creator.none.fl_str_mv Lopez-Campos JL
Navarrete BA
Soriano JB
Soler-Cataluña JJ
González-Moro JMR
Ferrer MEF
Rubio MC
author Lopez-Campos JL
author_facet Lopez-Campos JL
Navarrete BA
Soriano JB
Soler-Cataluña JJ
González-Moro JMR
Ferrer MEF
Rubio MC
author_role author
author2 Navarrete BA
Soriano JB
Soler-Cataluña JJ
González-Moro JMR
Ferrer MEF
Rubio MC
author2_role author
author
author
author
author
author
dc.subject.none.fl_str_mv COPD
clinical audit
pharmacological prescriptions
quality of care
topic COPD
clinical audit
pharmacological prescriptions
quality of care
description 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.
publishDate 2018
dc.date.none.fl_str_mv 2018
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://fisabio.portalinvestigacion.com/publicaciones/3749
url https://fisabio.portalinvestigacion.com/publicaciones/3749
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv DOVE MEDICAL PRESS LTD
publisher.none.fl_str_mv DOVE MEDICAL PRESS LTD
dc.source.none.fl_str_mv International Journal of Chronic Obstructive Pulmonary Disease
ISSN: 11782005
ISSNl: 11769106
reponame:r-FISABIO. Repositorio Institucional de Producción Científica
instname:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
instname_str Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
reponame_str r-FISABIO. Repositorio Institucional de Producción Científica
collection r-FISABIO. Repositorio Institucional de Producción Científica
repository.name.fl_str_mv
repository.mail.fl_str_mv
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