[Analysis of an intervention to improve health outcomes in acute exacerbations of COPD in primary care].
OBJECTIVE
To examine the impact of an intervention by Primary Care (PC) professionals of a Health District on the clinical outcomes for treating COPD exacerbations using a process and outcome indicators analysis (clinical audit).


METHODS
Observational, retrospective and prospective analysis cross-sectional audit of clinical practice SETTING: Malaga-Guadalhorce Sanitary District (DSMG).


METHODS
Patients with COPD exacerbations treated by the extra-hospital emergency services (n=523; 21% losses).


METHODS
Professional training in the usual clinical practice and inclusion of process indicators of COPD targets in relation to incentives.


METHODS
Comparison of external audit results (process and outcomes variables) from medical records and Health Outcomes (exacerbations, admissions). Variable response: Difference in exacerbations and admissions in 2 periods analysed. Bivariate and multivariate analysis.


RESULTS
Mean age was 75 (±9.3), 63.7% males with a BMI of 29.4 (±7.1), and 21% active smokers. Mean FEV1, 48.2% (±18.7). Mean exacerbations in the first period, 2.86 (±2.29) and in the second 1.36 (±1.56) (P<.001). Mean hospital admissions in the first and second period, 0.56 (±0.94) and 0.31 (±0.66) (P<.001), respectively. The decrease in the number of exacerbations was directly associated with having ≥2 exacerbations in the first period, reviewed in Primary Care, and inversely with heart failure and with having ≥2 exacerbations in the second period (R2=0.28; P<.001) CONCLUSIONS: The number of exacerbations and admissions decreased significantly in both periods assessed. However, the evaluated process indicators did not improve. Prospective intervention studies are necessary to establish the possible causal relationship.
Centro de Salud Victoria, Distrito Sanitario Málaga-Guadalhorce, Málaga, España. Electronic address: mjbujalance@hotmail.com.
María José
MJ
Bujalance-Zafra
Centro de Salud Victoria, Distrito Sanitario Málaga-Guadalhorce, Málaga, España.
Miguel
M
Domínguez-Santaella
Centro de Salud Ciudad Jardín, Distrito Sanitario Málaga-Guadalhorce, Málaga, España.
Antonio
A
Baca-Osorio
Centro de Salud Ciudad Jardín, Distrito Sanitario Málaga-Guadalhorce, Málaga, España.
Leovigildo
L
Ginel-Mendoza
Centro de Salud Victoria, Distrito Sanitario Málaga-Guadalhorce, Málaga, España.
Francisco Jesús
FJ
Fernández-Vargas
Centro de Salud Ciudad Jardín, Distrito Sanitario Málaga-Guadalhorce, Málaga, España.
Rafael
R
Poyato-Ramos
D000208:Acute Disease; D000368:Aged; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D011320:Primary Health Care; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D058996:Quality Improvement; D012189:Retrospective Studies
Atención primaria; Chronic obstructive pulmonary disease; Enfermedad pulmonar obstructiva crónica; Exacerbación; Primary health care; Recurrence
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