RT Journal Article
T1 Determinants for changing the treatment of COPD: a regression analysis from a clinical audit.
A1 López-Campos, Jose Luis
A1 Abad Arranz, María
A1 Calero Acuña, Carmen
A1 Romero Valero, Fernando
A1 Ayerbe García, Ruth
A1 Hidalgo Molina, Antonio
A1 Aguilar Perez-Grovas, Ricardo I
A1 García Gil, Francisco
A1 Casas Maldonado, Francisco
A1 Caballero Ballesteros, Laura
A1 Sánchez Palop, María
A1 Pérez-Tejero, Dolores
A1 Segado, Alejandro
A1 Calvo Bonachera, Jose
A1 Hernández Sierra, Bárbara
A1 Doménech, Adolfo
A1 Arroyo Varela, Macarena
A1 González Vargas, Francisco
A1 Cruz Rueda, Juan J
K1 airway diseases
K1 follow-up
K1 outpatient care
K1 quality of care
K1 respiratory diseases
K1 treatment strategies
AB 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. 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. 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. 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.
YR 2016
FD 2016-06-02
LK https://hdl.handle.net/10668/24507
UL https://hdl.handle.net/10668/24507
LA en
DS RISalud
RD Apr 5, 2025