Adherence to COPD guidelines in general practice: impact of an educational programme delivered on location in Danish general practices.
BACKGROUND
The general practitioner (GP) is often the first healthcare contact for patients with chronic obstructive pulmonary disease (COPD).


OBJECTIVE
To determine whether participating in a standardised educational programme delivered in the GP's own practice is associated with adherence to COPD guidelines.


METHODS
A nationwide register-based observational before and after study was undertaken with a control group of propensity-matched practices (follow-up period 6 months). COPD was defined as age 40+ years and at least two prescriptions for inhaled medication. The educational programme consisted of a 3-hr teaching lesson with a respiratory specialist and five visits by a representative from the sponsoring pharmaceutical company focusing on assessment and management of patients including written algorithms. A one-to-one propensity-matched control group of practices was selected. Register data were used to compare the rate of spirometry testing, preventive consultations, and influenza vaccinations provided to COPD patients and the rate of spirometry testing in non-COPD individuals, assumed to reflect diagnostic activity.


RESULTS
Data for 102 participating GP practices were analysed. Participating clinics had a significant increase in preventive consultations and influenza vaccinations (p<0.05). For the control group, a significant change was observed only for influenza vaccinations. No significant change was found when comparing participating and control clinics in the difference-in-difference estimator. However, a significant improvement was observed for the subgroup of 48 clinics with the lowest starting point of spirometry testing.


CONCLUSIONS
Focused education of GPs and their staff delivered in the GPs' own practices may improve adherence to COPD guidelines, not least for clinics with a high potential for improvement.
Respiratory Section, Internal Medicine Unit, Hvidovre University Hospital, Hvidovre, Denmark. csulrik@dadlnet.dk
Charlotte Suppli
CS
Ulrik
Tina Brandt
TB
Sørensen
Torben Brunse
TB
Højmark
Kim Rose
KR
Olsen
Peter
P
Vedsted
D000328:Adult; D003718:Denmark; D005260:Female; D058006:General Practice / Q000193:education*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*