ArticleInternational journal of chronic obstructive pulmonary disease2016
Determinants for changing the treatment of COPD: a regression analysis from a clinical audit.
Article in International journal of chronic obstructive pulmonary disease, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed, 15 citations in OpenAlex.
- Adjustments to maintenance therapy and the reasoning behind them among COPD outpatients in Austria: the STEP study.ERJ open research · 2024Article
- Factors Associated with the Non-Exacerbator Phenotype of Chronic Obstructive Pulmonary Disease.International journal of chronic obstructive pulmonary disease · 2023Article
- A Simplified Algorithm for the Diagnosis, Treatment, and Management of COPD in Routine Primary Care Practice.International journal of chronic obstructive pulmonary disease · 2020Article
- Are there specific clinical characteristics associated with physician's treatment choices in COPD?Respiratory research · 2019Article
- Alignment of Inhaled Chronic Obstructive Pulmonary Disease Therapies with Published Strategies. Analysis of the Global Initiative for Chronic Obstructive Lung Disease Recommendations in SPIROMICS.Annals of the American Thoracic Society · 2019Observational
- Determinants of medical prescriptions for COPD care: an analysis of the EPOCONSUL clinical audit.International journal of chronic obstructive pulmonary disease · 2018Observational
- Factors influencing pharmacological treatment in COPD: a comparison of 2005 and 2014.European clinical respiratory journal · 2017Article
- Seasonal variability in clinical care of COPD outpatients: results from the Andalusian COPD audit.International journal of chronic obstructive pulmonary disease · 2017Article
- Clinical audit of COPD in outpatient respiratory clinics in Spain: the EPOCONSUL study.International journal of chronic obstructive pulmonary disease · 2017Observational
- Persistent disabling breathlessness in chronic obstructive pulmonary disease.International journal of chronic obstructive pulmonary disease · 2016Article
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Authors and funding
19 authors at 10 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
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.
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