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