Physician and patient perceptions in COPD: the COPD Resource Network Needs Assessment Survey.
OBJECTIVE
Chronic obstructive pulmonary disease (COPD), the fourth leading cause of death in the United States, has received disproportionately little attention from physicians and institutions. National data are lacking on patient and physician perceptions of and patterns of care for COPD.


METHODS
Linked surveys were administered to national samples of patients with COPD, primary care physicians, and pulmonologists to evaluate perceptions of COPD severity and quality of life, attitudes about COPD, health insurance barriers to COPD care, sources of information, and knowledge about COPD diagnosis and treatment.


RESULTS
Overall, 1023 patients with COPD and 1051 primary care physicians and pulmonologists responded to the surveys. Despite experiencing significant symptoms and high health care use, the majority of patients were satisfied with their care. Eighty-eight percent of physicians agreed with the statement that COPD is a "self-inflicted" disease, and more than one third were nihilistic about the treatment of patients who continued to smoke. Patients and physicians reported that insurance problems impeded access to therapies. Patients were generally uninformed about COPD; 54% of primary care physicians were aware of any COPD guidelines. Both patient and physician surveys demonstrated continued confusion about the diagnosis of COPD and treatment choices. There was frequent use of regular oral steroids despite demonstrated lack of efficacy and under-use of pulmonary rehabilitation despite proven efficacy.


CONCLUSIONS
Patients with COPD have a high prevalence of activity limitations. Although most physicians believed that proper treatment can slow progression, inadequate knowledge and poor adherence to practice guidelines, together with insurance impediments, negatively impact COPD care.
Barr
R Graham
RG
Division of General Medicine, Department of Medicine, College of Physicians and Surgeons, Mailman School of Public Health, Columbia University, New York, NY, USA. rgb9@columbia.edu
Celli
Bartolome R
BR
Martinez
Fernando J
FJ
Ries
Andrew L
AL
Rennard
Stephen I
SI
Reilly
John J
JJ
Sciurba
Frank C
FC
Thomashow
Byron M
BM
Wise
Robert A
RA
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D011320:Primary Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000473:pathology* / Q000628:therapy*; D011788:Quality of Life