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Title: Variability in adherence to clinical practice guidelines and recommendations in COPD outpatients: a multi-level, cross-sectional analysis of the EPOCONSUL study.
Authors: Calle Rubio, Myriam
López-Campos, José Luis
Soler-Cataluña, Juan J
Alcázar Navarrete, Bernardino
Soriano, Joan B
Rodríguez González-Moro, José Miguel
Fuentes Ferrer, Manuel E
Rodríguez Hermosa, Juan Luis
Keywords: Adherence to recommendations;Chronic obstructive pulmonary disease;Clinical audit;Clinical practice guidelines;Medical care
metadata.dc.subject.mesh: Aged
Ambulatory Care
Cross-Sectional Studies
Guideline Adherence
Medical Audit
Middle Aged
Outpatient Clinics, Hospital
Practice Guidelines as Topic
Pulmonary Disease, Chronic Obstructive
Issue Date: 2-Dec-2017
Abstract: Clinical audits have reported considerable variability in COPD medical care and frequent inconsistencies with recommendations. The objectives of this study were to identify factors associated with a better adherence to clinical practice guidelines and to explore determinants of this variability at the the hospital level. EPOCONSUL is a Spanish nationwide clinical audit that evaluates the outpatient management of COPD. Multilevel logistic regression with two levels was performed to assess the relationships between individual and disease-related factors, as well as hospital characteristics. A total of 4508 clinical records of COPD patients from 59 Spanish hospitals were evaluated. High variability was observed among hospitals in terms of medical care. Some of the patient's characteristics (airflow obstruction, degree of dyspnea, exacerbation risk, presence of comorbidities), the hospital factors (size and respiratory nurses available) and treatment at a specialized COPD outpatient clinic were identified as factors associated with a better adherence to recommendations, although this only explains a small proportion of the total variance. To be treated at a specialized COPD outpatient clinic and some intrinsic patient characteristics were factors associated with a better adherence to guideline recommendations, although these variables were only explaining part of the high variability observed among hospitals in terms of COPD medical care.
metadata.dc.identifier.doi: 10.1186/s12931-017-0685-8
Appears in Collections:Producción 2020

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