%0 Journal Article
%A López-Campos, Jose Luis
%A Abad Arranz, María
%A Calero Acuña, Carmen
%A Romero Valero, Fernando
%A Ayerbe García, Ruth
%A Hidalgo Molina, Antonio
%A Aguilar Perez-Grovas, Ricardo I
%A García Gil, Francisco
%A Casas Maldonado, Francisco
%A Caballero Ballesteros, Laura
%A Sánchez Palop, María
%A Pérez-Tejero, Dolores
%A Segado, Alejandro
%A Calvo Bonachera, Jose
%A Hernández Sierra, Bárbara
%A Doménech, Adolfo
%A Arroyo Varela, Macarena
%A González Vargas, Francisco
%A Cruz Rueda, Juan J
%T Determinants for changing the treatment of COPD: a regression analysis from a clinical audit.
%D 2016
%@ 1176-9106
%U http://hdl.handle.net/10668/2480
%X INTRODUCTIONThis 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.METHODSThis 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.RESULTSThe 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.CONCLUSIONThe 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.
%K Quality of care
%K Outpatient care
%K Treatment strategies
%K Follow-up
%K Respiratory diseases
%K Airway diseases
%K Andalucía
%K Atención ambulatoria
%K Auditoría clínica
%K Estudios de seguimiento
%K Volumen espiratorio forzado
%K Servicio ambulatorio en hospital
%K Enfermedad pulmonar obstructiva crónica
%K España
%K Corticoesteroides
%K Antibacterianos
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