ArticleBMC medical research methodology2018
Community Assessment of COPD Health Care (COACH) study: a clinical audit on primary care performance variability in COPD care.
Article in BMC medical research methodology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 3 of them syntheses that pooled it.
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Who cites it
10 citing papers in PubMed, 3 syntheses or guidelines pooled it, 21 citations in OpenAlex.
- Pooled it
- Short-acting bronchodilators for the management of acute exacerbations of chronic obstructive pulmonary disease in the hospital setting: systematic review.Systematic reviews · 2018Pooled it
- Triple therapy for COPD: a crude analysis from a systematic review of the evidence.Therapeutic advances in respiratory diseasePooled it
- Reductions in inhaler greenhouse gas emissions by addressing care gaps in asthma and chronic obstructive pulmonary disease: an analysis.BMJ open respiratory research · 2023Article
- Does Evaluation and Management of COPD Follow Therapeutic Strategy Recommendations?Chronic obstructive pulmonary diseases (Miami, Fla.) · 2021Article
- Predictors of Single Bronchodilation Treatment Response for COPD: An Observational Study with the Trace Database Cohort.Journal of clinical medicine · 2021Article
- Step-Up and Step-Down Treatment Approaches for COPD: A Holistic View of Progressive Therapies.International journal of chronic obstructive pulmonary disease · 2021Review
- Effectiveness of an Intervention to Improve Management of COPD using the AUDIT Methodology: Results of the Neumo-Advance Study.Clinical drug investigation · 2019Article
- Quantification of inaccurate diagnosis of COPD in primary care medicine: an analysis of the COACH clinical audit.International journal of chronic obstructive pulmonary disease · 2019Observational
- Economic Impact of Low Adherence to COPD Management Guidelines in Spain.International journal of chronic obstructive pulmonary diseaseArticle
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Authors and funding
13 authors at 7 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundA thorough evaluation of the adequacy of clinical practice in a designated health care setting and temporal context is key for clinical care improvement. This study aimed to perform a clinical audit of primary care to evaluate clinical care delivered to patients with COPD in routine clinical practice.
methodsThe Community Assessment of COPD Health Care (COACH) study was an observational, multicenter, nationwide, non-interventional, retrospective, clinical audit of randomly selected primary care centers in Spain. Two different databases were built: the resources and organization database and the clinical database. From January 1, 2015 to December 31, 2016 consecutive clinical cases of COPD in each participating primary care center (PCC) were audited. For descriptive purposes, we collected data regarding the age at diagnosis of COPD and the age at audit, gender, the setting of the PCC (rural/urban), and comorbidities for each patient. Two guidelines widely and uniformly used in Spain were carefully reviewed to establish a benchmark of adequacy for the audited cases. Clinical performance was analyzed at the patient, center, and regional levels. The degree of adequacy was categorized as excellent (> 80%), good (60-80%), adequate (40-59%), inadequate (20-39%), and highly inadequate (< 20%).
resultsDuring the study 4307 cases from 63 primary care centers in 6 regions of the country were audited. Most evaluated parameters were judged to fall in the inadequate performance category. A correct diagnosis based on previous exposure plus spirometric obstruction was made in an average of 17.6% of cases, ranging from 9.8 to 23.3% depending on the region. During the audited visit, only 67 (1.6%) patients had current post-bronchodilator obstructive spirometry; 184 (4.3%) patients had current post-bronchodilator obstructive spirometry during either the audited or initial diagnostic visit. Evaluation of dyspnea was performed in 11.1% of cases. Regarding treatment, 33.6% received no maintenance inhaled therapies (ranging from 31.3% in GOLD A to 7.0% in GOLD D). The two most frequently registered items were exacerbations in the previous year (81.4%) and influenza vaccination (87.7%).
conclusionsThe results of this audit revealed a large variability in clinical performance across centers, which was not fully attributable to the severity of the disease.
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