title: Guideline Adherence in Outpatient Clinics for Chronic Obstructive Pulmonary Disease: Results from a Clinical Audit.
abstract: OBJECTIVE
  Previous clinical audits of COPD have provided relevant information about medical intervention in exacerbation admissions. The present study aims to evaluate adherence to current guidelines in COPD through a clinical audit.
  
  
  METHODS
  This is a pilot clinical audit performed in hospital outpatient respiratory clinics in Andalusia, Spain (eight provinces with more than 8 million inhabitants), including 9 centers (20% of the public centers in the area) between 2013 and 2014. Cases with an established diagnosis of COPD based on risk factors, clinical symptoms, and a post-bronchodilator FEV1/FVC ratio of less than 0.70 were deemed eligible. The performance of the outpatient clinics was benchmarked against three guidance documents available at the time of the audit. The appropriateness of the performance was categorized as excellent (>80%), good (60-80%), adequate (40-59%), inadequate (20-39%), and highly inadequate (<20%).
  
  
  RESULTS
  During the audit, 621 clinical records were audited. Adherence to the different guidelines presented a considerable variability among the different participating hospitals, with an excellent or good adherence for symptom recording, MRC or CAT use, smoking status evaluation, spirometry, or bronchodilation therapy. The most outstanding areas for improvement were the use of the BODE index, the monitoring of treatments, the determination of alpha1-antitrypsin, the performance of exercise testing, and vaccination recommendations.
  
  
  CONCLUSIONS
  The present study reflects the situation of clinical care for COPD patients in specialized secondary care outpatient clinics. Adherence to clinical guidelines shows considerable variability in outpatient clinics managing COPD patients, and some aspects of the clinical care can clearly be improved.
authors.affiliation: Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain.|CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Jose L
authors.initials: JL
authors.lastname: López-Campos
authors.affiliation: Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Abad Arranz
authors.affiliation: Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain.|CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Calero-Acuña
authors.affiliation: Hospital Puerta del Mar, Cádiz, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Romero-Valero
authors.affiliation: Hospital Juan Ramón Jiménez, Huelva, Spain.
authors.forename: Ruth
authors.initials: R
authors.lastname: Ayerbe-García
authors.affiliation: Hospital Puerta del Mar, Cádiz, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Hidalgo-Molina
authors.affiliation: Hospital Juan Ramón Jiménez, Huelva, Spain.
authors.forename: Ricardo I
authors.initials: RI
authors.lastname: Aguilar-Pérez-Grovas
authors.affiliation: Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: García-Gil
authors.affiliation: Hospital Universitario San Cecilio, Granada, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Casas-Maldonado
authors.affiliation: Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Caballero-Ballesteros
authors.affiliation: Hospital Universitario San Cecilio, Granada, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Sánchez-Palop
authors.affiliation: Hospital Infanta Margarita, Cabra, Córdoba, Spain.
authors.forename: Dolores
authors.initials: D
authors.lastname: Pérez-Tejero
authors.affiliation: Hospital Infanta Margarita, Cabra, Córdoba, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Segado
authors.affiliation: Hospital Torrecárdenas, Almería, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Calvo-Bonachera
authors.affiliation: Hospital Torrecárdenas, Almería, Spain.
authors.forename: Bárbara
authors.initials: B
authors.lastname: Hernández-Sierra
authors.affiliation: Hospital Regional Universitario de Málaga, Málaga, Spain.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Doménech
authors.affiliation: Hospital Regional Universitario de Málaga, Málaga, Spain.
authors.forename: Macarena
authors.initials: M
authors.lastname: Arroyo-Varela
authors.affiliation: Hospital Universitario Virgen de las Nieves, Granada, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: González-Vargas
authors.affiliation: Hospital Universitario Virgen de las Nieves, Granada, Spain.
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Cruz-Rueda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000592:standards*; D054869:Clinical Audit; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D017410:Practice Guidelines as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000628:therapy*