Date Published: February 6, 2019
Publisher: Public Library of Science
Author(s): Myriam Calle Rubio, Juan José Soler-Cataluña, José Luis López-Campos, Bernardino Alcázar Navarrete, José Miguel Rodríguez González-Moro, Joan B. Soriano, Manuel E. Fuentes Ferrer, Juan Luis Rodriguez Hermosa, Konstantinos Kostikas.
Chronic obstructive pulmonary disease (COPD) is one of the main reasons for healthcare appointments and use of healthcare resources. In recent years, clinics specializing in COPD have been developed to offer improved care and optimization of recourses for patients with high complexity and frequent decompensations. However, little is known about the clinical practice in this clinical model specializing in COPD. The objectives of this study were to assess the prevalence, characteristics of specialized COPD outpatient respiratory clinics and to evaluate clinical practice in this healthcare model.
EPOCONSUL is a Spanish nationwide, observational, cross-sectional, clinical audit with prospective case recruitment including the clinical records for 4508 COPD cases from outpatient respiratory clinics over a 12-month period (May 2014–May 2015). The study evaluated clinical practice in 2378 cases from 28 hospitals with both general and specialized COPD outpatient respiratory clinics.
Only 28 (47.5%) centers had an outpatient clinic specializing in COPD, which was characterized by longer patient visits and a higher prevalence of written protocols compared to a general clinic. Patients treated in a specialized clinic had greater obstruction severity, a higher degree of dyspnea and also suffered from more comorbidities. The majority of patients at both types of clinic were classified as high risk (81.1% versus 83%, p = 0.384) according to GesEPOC criteria. Clinical control of COPD was more frequent at specialized clinics, with significant differences in non-severe patients (70.5% versus 56.1%, p < 0.001). Testing was done more frequently in specialized clinics, with better adherence to good clinical practice recommendations. A specialized COPD outpatient clinic is a healthcare model found in few pulmonology departments that treats more severe patients and those with increased comorbidities. The COPD patients treated in a specialized clinic had a better clinical control, as defined by impact and clinical stability. It is a healthcare model to offer improved care with a higher degree of adherence to guidelines.
Often, one of the most important problems in the structure and organization of healthcare is the management of chronicity and patient complexity. According to data from the World Health Organization (WHO), chronic disease is the cause of 60% of deaths worldwide and results in 75% of public health costs. Furthermore, it is estimated that chronic disease will account for 60% of all disease worldwide by 2020 and will be responsible for 73% of deaths around the world [1–3].
The methodology of the EPOCONSUL audit has been extensively described elsewhere . Briefly, the COPD audit promoted by the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) was designed to evaluate clinical practice as well as clinical and organizational factors related to managing patients with COPD across Spain. It was designed as an observational, cross-sectional study. Recruitment was intermittent over a single year (May 2014–May 2015). Every 2 months, each investigator recorded the clinical records of the first 10 patients identified as being diagnosed with COPD and seen in the outpatient respiratory clinic (general or specializing in COPD). Subsequently, the patients identified were reevaluated to determine if they met the inclusion/exclusion criteria described in S1 Table. The information collected was historical in nature for the clinical data from the last and previous visits, and information about hospital resources was concurrent. 46 variables associated with the hospitals and 153 associated with the patients were collected. Data from this study is included in S1 File and S2 File.
This paper provides data on clinical practice and the characteristics of patients treated in specialized COPD outpatient clinics compared to general clinics in pulmonology departments in Spain for the first time.
A specialized COPD outpatient respiratory clinic is a healthcare model present in very few pulmonology departments in Spain. It is characterized by a greater amount of time reserved for patient care and creating protocols for care, although it does not have additional human resources or equipment available. This formula has been proven to offer a better clinical control of COPD with greater adherence to clinical practice guidelines. However, future studies are needed in order to evaluate whether it has an impact on clinically relevant results.