Please use this identifier to cite or link to this item: http://hdl.handle.net/10668/2480
Título : Determinants for changing the treatment of COPD: a regression analysis from a clinical audit.
Autor : López-Campos, Jose Luis
Abad Arranz, María
Calero Acuña, Carmen
Romero Valero, Fernando
Ayerbe García, Ruth
Hidalgo Molina, Antonio
Aguilar Perez-Grovas, Ricardo I
García Gil, Francisco
Casas Maldonado, Francisco
Caballero Ballesteros, Laura
Sánchez Palop, María
Pérez-Tejero, Dolores
Segado, Alejandro
Calvo Bonachera, Jose
Hernández Sierra, Bárbara
Doménech, Adolfo
Arroyo Varela, Macarena
González Vargas, Francisco
Cruz Rueda, Juan J
Filiación: [López-Campos,JL; Abad Arranz, M; Calero Acuña,C] Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain. [López-Campos,JL; Calero Acuña,C] Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. [Romero Valero,F; Hidalgo Molina,A] Hospital Universitario Puerta del Mar, Cádiz, Spain. [Aguilar Perez-Grovas,RI] Hospital Juan Ramón Jiménez, Huelva, Spain. [García Gil,F; Caballero Ballesteros,L] Hospital Universitario Reina Sofía, Córdoba, Spain. [Casas Maldonado,F; Sánchez Palop,M] Hospital Universitario San Cecilio, Granada, Spain. [Pérez-Tejero,D; Segado,A] Hospital Infanta Margarita, Cabra, Córdoba, Spain. [Calvo Bonachera,J; Hernández Sierra,B] Hospital Torrecárdenas, Almería, Spain. [Doménech,A; Arroyo Varela,M] Hospital Regional Universitario de Málaga, Spain. [González Vargas,F; Cruz Rueda,JJ] Hospital Universitario Virgen de las Nieves, Granada, Spain.
Palabras clave : Quality of care
Outpatient care
Treatment strategies
Follow-up
Respiratory diseases
Airway diseases
Andalucía
Atención ambulatoria
Auditoría clínica
Estudios de seguimiento
Volumen espiratorio forzado
Servicio ambulatorio en hospital
Enfermedad pulmonar obstructiva crónica
España
Corticoesteroides
Antibacterianos
MeSH: Medical Subject Headings::Health Care::Health Care Facilities, Manpower, and Services::Health Services::Patient Care::Ambulatory Care
Medical Subject Headings::Health Care::Health Care Quality, Access, and Evaluation::Quality Assurance, Health Care::Clinical Audit
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Longitudinal Studies::Follow-Up Studies
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Diagnostic Techniques and Procedures::Diagnostic Techniques, Respiratory System::Respiratory Function Tests::Pulmonary Ventilation::Forced Expiratory Volume
Medical Subject Headings::Health Care::Health Care Facilities, Manpower, and Services::Health Facilities::Ambulatory Care Facilities::Outpatient Clinics, Hospital
Medical Subject Headings::Diseases::Respiratory Tract Diseases::Lung Diseases::Lung Diseases, Obstructive::Pulmonary Disease, Chronic Obstructive
Medical Subject Headings::Geographicals::Geographic Locations::Europe::Spain
Medical Subject Headings::Chemicals and Drugs::Hormones, Hormone Substitutes, and Hormone Antagonists::Hormones::Adrenal Cortex Hormones
Medical Subject Headings::Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents::Anti-Bacterial Agents
Fecha de publicación : 2-Jun-2016
Editorial : Dove Medical Press
Cita Bibliográfica: López-Campos JL, Abad Arranz M, Calero Acuña C, Romero Valero F, Ayerbe García R, Hidalgo Molina A, et al. Determinants for changing the treatment of COPD: a regression analysis from a clinical audit. Int J Chron Obstruct Pulmon Dis. 2016; 11:1171-8
Abstract: INTRODUCTION This 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. METHODS This 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. RESULTS The 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. CONCLUSION The 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.
Descripción : Journal Article;
URI: http://hdl.handle.net/10668/2480
Versión del editor : https://www.dovepress.com/determinants-for-changing-the-treatment-of-copd-a-regression-analysis--peer-reviewed-article-COPD
DOI: 10.2147/COPD.S103614
ISSN : 1178-2005 (Online)
1176-9106 (Print)
Appears in Collections:01- Artículos - Hospital Regional de Málaga
01- Artículos - Complejo Hospitalario Torrecárdenas
01- Artículos - AGS Sur de Córdoba
01- Artículos - Hospital Reina Sofía
01- Artículos - Complejo Hospitalario Universitario de Huelva
01- Artículos - Hospital Puerta del Mar
01- Artículos - Hospital Virgen del Rocío
01- Artículos - IBIS. Instituto de Biomedicina de Sevilla
01- Artículos - Complejo Hospitalario Universitario de Granada

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