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Determinants for changing the treatment of COPD: a regression analysis from a clinical audit.

dc.contributor.authorLópez-Campos, Jose Luis
dc.contributor.authorAbad Arranz, María
dc.contributor.authorCalero Acuña, Carmen
dc.contributor.authorRomero Valero, Fernando
dc.contributor.authorAyerbe García, Ruth
dc.contributor.authorHidalgo Molina, Antonio
dc.contributor.authorAguilar Perez-Grovas, Ricardo I
dc.contributor.authorGarcía Gil, Francisco
dc.contributor.authorCasas Maldonado, Francisco
dc.contributor.authorCaballero Ballesteros, Laura
dc.contributor.authorSánchez Palop, María
dc.contributor.authorPérez-Tejero, Dolores
dc.contributor.authorSegado, Alejandro
dc.contributor.authorCalvo Bonachera, Jose
dc.contributor.authorHernández Sierra, Bárbara
dc.contributor.authorDoménech, Adolfo
dc.contributor.authorArroyo Varela, Macarena
dc.contributor.authorGonzález Vargas, Francisco
dc.contributor.authorCruz Rueda, Juan J
dc.contributor.authoraffiliation[López-Campos,JL; Abad Arranz, M; Calero Acuña,C] Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain. [López-Campos,JL; Calero Acuña,C] Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. [Romero Valero,F; Hidalgo Molina,A] Hospital Universitario Puerta del Mar, Cádiz, Spain. [Aguilar Perez-Grovas,RI] Hospital Juan Ramón Jiménez, Huelva, Spain. [García Gil,F; Caballero Ballesteros,L] Hospital Universitario Reina Sofía, Córdoba, Spain. [Casas Maldonado,F; Sánchez Palop,M] Hospital Universitario San Cecilio, Granada, Spain. [Pérez-Tejero,D; Segado,A] Hospital Infanta Margarita, Cabra, Córdoba, Spain. [Calvo Bonachera,J; Hernández Sierra,B] Hospital Torrecárdenas, Almería, Spain. [Doménech,A; Arroyo Varela,M] Hospital Regional Universitario de Málaga, Spain. [González Vargas,F; Cruz Rueda,JJ] Hospital Universitario Virgen de las Nieves, Granada, Spain.es
dc.contributor.funderThis study was financially supported by an unrestricted grant from Laboratorios Menarini, SA (Barcelona, Spain).
dc.date.accessioned2016-10-21T08:24:10Z
dc.date.available2016-10-21T08:24:10Z
dc.date.issued2016-06-02
dc.descriptionJournal Article;es
dc.description.abstractINTRODUCTION 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.es
dc.description.versionYeses
dc.identifier.citationLópez-Campos JL, Abad Arranz M, Calero Acuña C, Romero Valero F, Ayerbe García R, Hidalgo Molina A, et al. Determinants for changing the treatment of COPD: a regression analysis from a clinical audit. Int J Chron Obstruct Pulmon Dis. 2016; 11:1171-8es
dc.identifier.doi10.2147/COPD.S103614
dc.identifier.essn1178-2005
dc.identifier.issn1176-9106
dc.identifier.pmcPMC4898035
dc.identifier.pmid27330285
dc.identifier.urihttp://hdl.handle.net/10668/2480
dc.journal.titleInternational Journal of Chronic Obstructive Pulmonary Disease
dc.language.isoen
dc.organizationAGS Sur de Córdoba
dc.publisherDove Medical Presses
dc.relation.publisherversionhttps://www.dovepress.com/determinants-for-changing-the-treatment-of-copd-a-regression-analysis--peer-reviewed-article-COPDes
dc.rights.accessRightsopen access
dc.subjectQuality of carees
dc.subjectOutpatient carees
dc.subjectTreatment strategieses
dc.subjectFollow-upes
dc.subjectRespiratory diseaseses
dc.subjectAirway diseaseses
dc.subjectAndalucíaes
dc.subjectAtención ambulatoriaes
dc.subjectAuditoría clínicaes
dc.subjectEstudios de seguimientoes
dc.subjectVolumen espiratorio forzadoes
dc.subjectServicio ambulatorio en hospitales
dc.subjectEnfermedad pulmonar obstructiva crónicaes
dc.subjectEspañaes
dc.subjectCorticoesteroideses
dc.subjectAntibacterianoses
dc.subject.meshMedical Subject Headings::Health Care::Health Care Facilities, Manpower, and Services::Health Services::Patient Care::Ambulatory Carees
dc.subject.meshMedical Subject Headings::Health Care::Health Care Quality, Access, and Evaluation::Quality Assurance, Health Care::Clinical Audites
dc.subject.meshMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Longitudinal Studies::Follow-Up Studieses
dc.subject.meshMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Diagnostic Techniques and Procedures::Diagnostic Techniques, Respiratory System::Respiratory Function Tests::Pulmonary Ventilation::Forced Expiratory Volumees
dc.subject.meshMedical Subject Headings::Health Care::Health Care Facilities, Manpower, and Services::Health Facilities::Ambulatory Care Facilities::Outpatient Clinics, Hospitales
dc.subject.meshMedical Subject Headings::Diseases::Respiratory Tract Diseases::Lung Diseases::Lung Diseases, Obstructive::Pulmonary Disease, Chronic Obstructivees
dc.subject.meshMedical Subject Headings::Geographicals::Geographic Locations::Europe::Spaines
dc.subject.meshMedical Subject Headings::Chemicals and Drugs::Hormones, Hormone Substitutes, and Hormone Antagonists::Hormones::Adrenal Cortex Hormoneses
dc.subject.meshMedical Subject Headings::Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents::Anti-Bacterial Agentses
dc.titleDeterminants for changing the treatment of COPD: a regression analysis from a clinical audit.es
dc.typeresearch article
dc.type.hasVersionVoR
dspace.entity.typePublication

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