Determinants for changing the treatment of COPD: a regression analysis from a clinical audit
Jose Luis López-Campos,1,2 María Abad Arranz,1 Carmen Calero Acuña,1,2 Fernando Romero Valero,3 Ruth Ayerbe García,4 Antonio Hidalgo Molina,3 Ricardo I Aguilar Perez-Grovas,4 Francisco García Gil,5 Francisco Casas Maldonado,6 Laura Caballero Bal...
| Main Authors: | , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Dove Medical Press
2016-06-01
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| Series: | International Journal of COPD |
| Subjects: | |
| Online Access: | https://www.dovepress.com/determinants-for-changing-the-treatment-of-copd-a-regression-analysis--peer-reviewed-article-COPD |
| _version_ | 1818048561719279616 |
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| author | López-Campos JL Abad Arranz M Calero Acuña C Romero Valero F Ayerbe García R Hidalgo Molina A Aguilar Perez-Grovas RI García Gil F Casas Maldonado F Caballero Ballesteros L Sánchez Palop M Pérez-Tejero D Segado A Calvo Bonachera J Hernández Sierra B Doménech A Arroyo Varela M González Vargas F Cruz Rueda JJ |
| author_facet | López-Campos JL Abad Arranz M Calero Acuña C Romero Valero F Ayerbe García R Hidalgo Molina A Aguilar Perez-Grovas RI García Gil F Casas Maldonado F Caballero Ballesteros L Sánchez Palop M Pérez-Tejero D Segado A Calvo Bonachera J Hernández Sierra B Doménech A Arroyo Varela M González Vargas F Cruz Rueda JJ |
| author_sort | López-Campos JL |
| collection | DOAJ |
| description | Jose Luis López-Campos,1,2 María Abad Arranz,1 Carmen Calero Acuña,1,2 Fernando Romero Valero,3 Ruth Ayerbe García,4 Antonio Hidalgo Molina,3 Ricardo I Aguilar Perez-Grovas,4 Francisco García Gil,5 Francisco Casas Maldonado,6 Laura Caballero Ballesteros,5 María Sánchez Palop,6 Dolores Pérez-Tejero,7 Alejandro Segado,7 Jose Calvo Bonachera,8 Bárbara Hernández Sierra,8 Adolfo Doménech,9 Macarena Arroyo Varela,9 Francisco González Vargas,10 Juan J Cruz Rueda10 1Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, 2Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, 3Hospital Universitario Puerta del Mar, Cádiz, 4Hospital Juan Ramón Jiménez, Huelva, 5Hospital Universitario Reina Sofía, Córdoba, 6Hospital Universitario San Cecilio, Granada, 7Hospital Infanta Margarita, Cabra, Córdoba, 8Hospital Torrecárdenas, Almería, 9Hospital Regional Universitario de Málaga, 10Hospital Universitario Virgen de las Nieves, Granada, Spain Introduction: This study is an analysis of a pilot COPD clinical audit that evaluated adherence to guidelines for patients with COPD in a stable disease phase during a routine visit in specialized secondary care outpatient clinics in order to identify the variables associated with the decision to step-up or step-down pharmacological treatment.Methods: This study was a pilot clinical audit performed at hospital outpatient respiratory clinics in the region of Andalusia, Spain (eight provinces with over eight million inhabitants), in which 20% of centers in the area (catchment population 3,143,086 inhabitants) were invited to participate. Treatment changes were evaluated in terms of the number of prescribed medications and were classified as step-up, step-down, or no change. Three backward stepwise binominal multivariate logistic regression analyses were conducted to evaluate variables associated with stepping up, stepping down, and inhaled corticosteroids discontinuation.Results: The present analysis evaluated 565 clinical records (91%) of the complete audit. Of those records, 366 (64.8%) cases saw no change in pharmacological treatment, while 99 patients (17.5%) had an increase in the number of drugs, 55 (9.7%) had a decrease in the number of drugs, and 45 (8.0%) noted a change to other medication for a similar therapeutic scheme. Exacerbations were the main factor in stepping up treatment, as were the symptoms themselves. In contrast, rather than symptoms, doctors used forced expiratory volume in 1 second and previous treatment with long-term antibiotics or inhaled corticosteroids as the key determinants to stepping down treatment.Conclusion: The majority of doctors did not change the prescription. When changes were made, a number of related factors were noted. Future trials must evaluate whether these therapeutic changes impact clinically relevant outcomes at follow-up. Keywords: quality of care, outpatient care, treatment strategies, follow-up, respiratory diseases, airway diseases |
| first_indexed | 2024-12-10T10:23:39Z |
| format | Article |
| id | doaj.art-82f8e018d87c4e559ddf8bf5ae567fad |
| institution | Directory Open Access Journal |
| issn | 1178-2005 |
| language | English |
| last_indexed | 2024-12-10T10:23:39Z |
| publishDate | 2016-06-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | International Journal of COPD |
| spelling | doaj.art-82f8e018d87c4e559ddf8bf5ae567fad2022-12-22T01:52:48ZengDove Medical PressInternational Journal of COPD1178-20052016-06-012016Issue 11171117827257Determinants for changing the treatment of COPD: a regression analysis from a clinical auditLópez-Campos JLAbad Arranz MCalero Acuña CRomero Valero FAyerbe García RHidalgo Molina AAguilar Perez-Grovas RIGarcía Gil FCasas Maldonado FCaballero Ballesteros LSánchez Palop MPérez-Tejero DSegado ACalvo Bonachera JHernández Sierra BDoménech AArroyo Varela MGonzález Vargas FCruz Rueda JJJose Luis López-Campos,1,2 María Abad Arranz,1 Carmen Calero Acuña,1,2 Fernando Romero Valero,3 Ruth Ayerbe García,4 Antonio Hidalgo Molina,3 Ricardo I Aguilar Perez-Grovas,4 Francisco García Gil,5 Francisco Casas Maldonado,6 Laura Caballero Ballesteros,5 María Sánchez Palop,6 Dolores Pérez-Tejero,7 Alejandro Segado,7 Jose Calvo Bonachera,8 Bárbara Hernández Sierra,8 Adolfo Doménech,9 Macarena Arroyo Varela,9 Francisco González Vargas,10 Juan J Cruz Rueda10 1Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, 2Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, 3Hospital Universitario Puerta del Mar, Cádiz, 4Hospital Juan Ramón Jiménez, Huelva, 5Hospital Universitario Reina Sofía, Córdoba, 6Hospital Universitario San Cecilio, Granada, 7Hospital Infanta Margarita, Cabra, Córdoba, 8Hospital Torrecárdenas, Almería, 9Hospital Regional Universitario de Málaga, 10Hospital Universitario Virgen de las Nieves, Granada, Spain Introduction: This study is an analysis of a pilot COPD clinical audit that evaluated adherence to guidelines for patients with COPD in a stable disease phase during a routine visit in specialized secondary care outpatient clinics in order to identify the variables associated with the decision to step-up or step-down pharmacological treatment.Methods: This study was a pilot clinical audit performed at hospital outpatient respiratory clinics in the region of Andalusia, Spain (eight provinces with over eight million inhabitants), in which 20% of centers in the area (catchment population 3,143,086 inhabitants) were invited to participate. Treatment changes were evaluated in terms of the number of prescribed medications and were classified as step-up, step-down, or no change. Three backward stepwise binominal multivariate logistic regression analyses were conducted to evaluate variables associated with stepping up, stepping down, and inhaled corticosteroids discontinuation.Results: The present analysis evaluated 565 clinical records (91%) of the complete audit. Of those records, 366 (64.8%) cases saw no change in pharmacological treatment, while 99 patients (17.5%) had an increase in the number of drugs, 55 (9.7%) had a decrease in the number of drugs, and 45 (8.0%) noted a change to other medication for a similar therapeutic scheme. Exacerbations were the main factor in stepping up treatment, as were the symptoms themselves. In contrast, rather than symptoms, doctors used forced expiratory volume in 1 second and previous treatment with long-term antibiotics or inhaled corticosteroids as the key determinants to stepping down treatment.Conclusion: The majority of doctors did not change the prescription. When changes were made, a number of related factors were noted. Future trials must evaluate whether these therapeutic changes impact clinically relevant outcomes at follow-up. Keywords: quality of care, outpatient care, treatment strategies, follow-up, respiratory diseases, airway diseaseshttps://www.dovepress.com/determinants-for-changing-the-treatment-of-copd-a-regression-analysis--peer-reviewed-article-COPDCOPDclinical auditquality of careoutpatient clinics |
| spellingShingle | López-Campos JL Abad Arranz M Calero Acuña C Romero Valero F Ayerbe García R Hidalgo Molina A Aguilar Perez-Grovas RI García Gil F Casas Maldonado F Caballero Ballesteros L Sánchez Palop M Pérez-Tejero D Segado A Calvo Bonachera J Hernández Sierra B Doménech A Arroyo Varela M González Vargas F Cruz Rueda JJ Determinants for changing the treatment of COPD: a regression analysis from a clinical audit International Journal of COPD COPD clinical audit quality of care outpatient clinics |
| title | Determinants for changing the treatment of COPD: a regression analysis from a clinical audit |
| title_full | Determinants for changing the treatment of COPD: a regression analysis from a clinical audit |
| title_fullStr | Determinants for changing the treatment of COPD: a regression analysis from a clinical audit |
| title_full_unstemmed | Determinants for changing the treatment of COPD: a regression analysis from a clinical audit |
| title_short | Determinants for changing the treatment of COPD: a regression analysis from a clinical audit |
| title_sort | determinants for changing the treatment of copd a regression analysis from a clinical audit |
| topic | COPD clinical audit quality of care outpatient clinics |
| url | https://www.dovepress.com/determinants-for-changing-the-treatment-of-copd-a-regression-analysis--peer-reviewed-article-COPD |
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