title: Management of chronic obstructive pulmonary disease in Swiss primary care: room for improvement.
abstract: BACKGROUND
  Information on the quality of care for patients with chronic obstructive pulmonary disease (COPD) in Swiss primary care is limited.
  
  
  OBJECTIVE
  To identify gaps and quality improvement potential in COPD primary care in Switzerland.
  
  
  METHODS
  Pooled analysis  of selected published data. Six international COPD guidelines (German, Swiss, United Kingdom, Canadian, Australian and New Zealand, and the global initiative on obstructive lung disease [GOLD] guidelines) were reviewed for care elements with a level of evidence rated II and higher in at least  three of the six guidelines. We compared published data on COPD management in Swiss primary care with these recommendations and with published international benchmarks.
  
  
  RESULTS
  Nine elements fulfilled the criteria for evidence level II or higher in at least three of six COPD guidelines.  These were summarised in six key domains: diagnosis, smoking cessation counselling, influenza vaccination, pharmacological treatment, patient education and pulmonary rehabilitation (long-term oxygen and palliative care are not the focus of COPD primary care in Switzerland and outpatient exacerbation  management was subordinated to pharmacological treatment and education). Swiss primary care data revealed spirometric confirmation of diagnosis in 55% of patients, smoking cessation counselling in 50% and influenza vaccination in 66%. Inadequate prescription of inhaled corticosteroids (ICS)  was high at 38% in mild COPD and 43% in moderate COPD. Referral for pulmonary rehabilitation, even for patients with severe COPD, was low at 19% and data on patient education were rare. Diagnosis, patient education and referral for pulmonary rehabilitation revealed the highest, and influenza  vaccination the lowest performance gap.
  
  
  CONCLUSIONS
  Gaps between current care and recommended best practice exist in Swiss primary care COPD management. Promoting and implementing evidence-based frameworks for developing high quality care for patients with COPD are necessary.
authors.affiliation: Institute of General Practice, University of Zurich, Pestalozzistrasse 24, 8091 Zurich, Switzerland. claudia.stey@usz.ch
authors.forename: Claudia
authors.initials: C
authors.lastname: Steurer-Stey
authors.forename: Kaba
authors.initials: K
authors.lastname: Dallalana
authors.forename: Marc
authors.initials: M
authors.lastname: Jungi
authors.forename: Thomas
authors.initials: T
authors.lastname: Rosemann
mesh_terms: D019985:Benchmarking; D055317:Evidence-Based Practice; D006801:Humans; D011320:Primary Health Care / Q000592:standards*; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000628:therapy*; D011787:Quality of Health Care; D013557:Switzerland