Management of COPD in general practice in Denmark – participating in an educational program substantially improves adherence to guidelines
Charlotte Suppli Ulrik1, Ejvind Frausing Hansen1, Michael Skov Jensen2, Finn Vejlø Rasmussen3, Jens Dollerup4, Gert Hansen4, Klaus Kaae Andersen5 on behalf of the KVASIMODO II study group
1Department of Cardiology and Respiratory Medicine, Hvidovre Hospital, Copenhagen, Denmark; 2Department of Internal Medicine, Skive Hospital, Skive, Denmark; 3Department of Respiratory Medicine, Bispebjerg Hospital, Copenhagen, Denmark; 4Pfizer Aps, Ballerup, Denmark; 5Informatics, Section for Statistics, Technical University of Denmark, Lyngby, Denmark
Background and aim: The general practitioner (GP) is the first contact with the health care system for most patients with COPD in Denmark. We studied, if participating in an educational program could improve adherence to guidelines, not least for diagnosis, staging, and treatment of the disease.
Design and setting: Two cross-sectional surveys were performed precisely one year apart before and after an educational program for the participating GPs. A total of 124 GPs completed the study; 1716 and 1342 patients with GP-diagnosed COPD and no concomitant asthma, respectively, were included in the two surveys.
Results: The proportion of patients having FEV1 registered in the GPs files increased from 45% to 69% (P < 0.001); and, furthermore, FEV1 % of predicted was recorded in 30% and 56%, respectively, of the cases (P < 0.001). In line with this, significant improvements were also observed for registration of smoking status (69% to 85%), BMI (8% to 40%), severity of dyspnea (Medical Research Council) (7% to 38%), and FEV1/FVC ratio (28% to 58%) (P < 0.001). Concerning the management options, improvements were also observed with regard to antismoking counseling, inhalator technique, physical activity, and referral for rehabilitation; use of inhaled corticosteroids in patients with mild COPD (FEV1 > 80%pred) declined from 76% to 45%.
Conclusion: Diagnosis and management of COPD in general practice in Denmark is not according to guidelines, but substantial improvements can be achieved by focused education of GPs and their staff.
Keywords: COPD, guidelines, adherence, education, diagnosis, management
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