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Multicenter Study
. 2016 Jun 2:11:1171-8.
doi: 10.2147/COPD.S103614. eCollection 2016.

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

Jose Luis López-Campos  1 , María Abad Arranz  2 , Carmen Calero Acuña  1 , 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 Rueda  10
Affiliations
Multicenter Study

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

Jose Luis López-Campos et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

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: airway diseases; follow-up; outpatient care; quality of care; respiratory diseases; treatment strategies.

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