title: Audit on the appropriateness of integrated COPD management: the "ALT-BPCO" project.
abstract: BACKGROUND
  Non communicable chronic diseases (including respiratory ones) are the leading cause of death and disability. To cope with them we need to redesign the health system, improving primary prevention, screening, and outpatient services, while fully integrating different branches of the health service. The Italian Ministry of Health published extended guidelines on integrated COPD management (COPD-GL) in 2010. In2011 a condensed version was produced. These documents define appropriateness of management regarding both the specialist and the health service.
  
  
  METHODS
  An internal audit on how clinical practice conforms to COPD-GL standards was implemented in one Italian region involving 29 respiratory units (RU) (65.8% of the total regional RU): data were collected from the clinical database at time zero and after 6 months. In the meantime, specialists of RU underwent education on COPD-GL.
  
  
  RESULTS
  At time zero, significant gaps between current practice and recommendations emerged both in medical practice (mean agreement 25%) and in the health organization (48%). At month 6 the gaps were reduced more in clinical practice (60.7%) than in organization (54.7%).
  
  
  CONCLUSIONS
  It is easier to resolve the gaps in specialist clinical practice than the organizational gaps, changing which is the politicians' task. Correcting specialists' inappropriateness may be worthless if this is not accompanied by improvement of the organizational obstacles. The search for appropriateness should not be limited only to specialists or to a strict control of drug prescription but should include all the organizational aspects. Implementation of COPD-GL calls for actions on the part of both specialists and the health system.
authors.affiliation: Vice President/President Elect Interdisciplinary Association for Research in Lung Disease (AIMAR), Arona, NO, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Nardini
authors.affiliation: Pulmonary Division Unit, Cava de' Tirreni, SA, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Cicchitto
authors.affiliation: AIMAR President, Arona, NO, Italy.
authors.forename: Fernando
authors.initials: F
authors.lastname: De Benedetto
authors.affiliation: AIMAR Past President, Mondo Medico, Borgomanero, NO, Italy.
authors.forename: Claudio F
authors.initials: CF
authors.lastname: Donner
authors.affiliation: Secretary General/Treasurer AIMAR, High Specialty Provincial Pulmonologic Unit, "Scarlato" Hospital, Scafati, (SA), Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Polverino
authors.affiliation: Managing Director Multidisciplinary Respiratory Medicine, Rome, Italy.
authors.forename: Claudio M
authors.initials: CM
authors.lastname: Sanguinetti
authors.affiliation: Scientific Secretary AIMAR, Arona, NO, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Visconti
keywords: Appropriateness; Assistance; Health organization; Specialized pulmonology practice
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