Assessing the clinical practice in specialized outpatient clinics for chronic obstructive pulmonary disease: Analysis of the EPOCONSUL clinical audit

• Published in: PloS one Vol. 14; no. 2; p. e0211732
• Main Authors: Calle Rubio, Myriam, Soler-Cataluña, Juan José, López-Campos, José Luis, Alcázar Navarrete, Bernardino, Rodríguez González-Moro, José Miguel, Soriano, Joan B, Fuentes Ferrer, Manuel E, Rodriguez Hermosa, Juan Luis
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 06.02.2019; Public Library of Science (PLoS)
• Subjects: Aged; Ambulatory care facilities; Ambulatory Care Facilities - statistics & numerical data; Analysis; Audits; Biology and Life Sciences; Chronic diseases; Chronic illnesses; Chronic obstructive lung disease; Chronic obstructive pulmonary disease; Clinical Audit; Clinical medicine; Comorbidity; Control stability; Cross-Sectional Studies; Design; Dyspnea; Efficiency; Epidemiology; Female; Guideline Adherence - statistics & numerical data; Health aspects; Health care; Health care reform; Hospitals; Humans; Lung diseases; Male; Medical records; Medicine; Medicine and Health Sciences; Middle Aged; Mortality; Obstructive lung disease; Optimization; Outpatient care facilities; Patients; People and places; Practice Patterns, Physicians; Pulmonary Disease, Chronic Obstructive - therapy; Quality of Health Care; Research and Analysis Methods; Respiration; Respiratory tract diseases; Spain; Thoracic surgery; Spain
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0211732

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.