title: Patient-centred assessment of COPD in primary care:  experience from a cross-sectional study of health-related  quality of life in Europe.
abstract: BACKGROUND
  Most patients with chronic obstructive pulmonary disease (COPD) in Europe are treated in primary care, but perceptions on what guides primary care physicians (PCPs) in managing patients are lacking.
  
  
  OBJECTIVE
  To describe factors associated with the assessment by PCPs of COPD severity and those associated with impaired health status, as assessed by patient-reported outcomes.
  
  
  METHODS
  This cross-sectional study evaluated health-related quality of life (HRQL) in 2,294 COPD patients from five European countries. The severity of COPD was clinically judged by the PCPs and GOLD stage severity was calculated using spirometry data.
  
  
  RESULTS
  PCPs' categories of severity reflected a wider range of HRQL scores (St George's Respiratory Questionnaire (SGRQ) total score: mild 30.3; moderate 41.7; severe 55.0; very severe 66.1) than GOLD severity grading (Stage I 38.2; Stage II 41.1; Stage III 49.9; Stage IV 58.5). Multiple ordinal logistic regression models showed that factors most closely related to PCP-rated COPD severity were Medical Research Council (MRC) dyspnoea grade, forced expiratory volume in 1 second (FEV₁) percent predicted, HRQL score (either SGRQ or COPD Assessment Test (CAT)), and previous hospitalisations (model generalised R²=0.45 or 0.44 (SQRQ or CAT in model, respectively); all factors p<0.0001). Factors with the highest association with HRQL scores (SGRQ or CAT) were MRC dyspnoea grade, COPD severity (PCP-rated), sputum production, and number of co-morbidities (model R²=0.46 or 0.37 (SQRQ or CAT in multiple linear regression model, respectively); all factors p<0.0001).
  
  
  CONCLUSIONS
  PCPs successfully graded COPD severity clinically and appeared to have greater discriminative power for assessing severity in COPD than FEV₁-based staging. Their more holistic approach appeared to reflect the patients' HRQL rating and was consistent across five European countries.
authors.affiliation: Division of Clinical Science, St George's, University of London, London, UK. pjones@sghms.ac.uk
authors.forename: Paul W
authors.initials: PW
authors.lastname: Jones
authors.forename: Guy
authors.initials: G
authors.lastname: Brusselle
authors.forename: Roberto W
authors.initials: RW
authors.lastname: Dal Negro
authors.forename: Montse
authors.initials: M
authors.lastname: Ferrer
authors.forename: Peter
authors.initials: P
authors.lastname: Kardos
authors.forename: Mark L
authors.initials: ML
authors.lastname: Levy
authors.forename: Thierry
authors.initials: T
authors.lastname: Perez
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Soler Cataluña
authors.forename: Thys
authors.initials: T
authors.lastname: van der Molen
authors.forename: Lukasz
authors.initials: L
authors.lastname: Adamek
authors.forename: Norbert
authors.initials: N
authors.lastname: Banik
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care; D011320:Primary Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis*; D011788:Quality of Life; D012720:Severity of Illness Index