Clinical audit of COPD in outpatient respiratory clinics in Spain: the EPOCONSUL study.
BACKGROUND
Chronic obstructive pulmonary disease (COPD) outpatients account for a large burden of usual care by respirologists. EPOCONSUL is the first national clinical audit conducted in Spain on the medical care for COPD patients delivered in outpatient respiratory clinics. We aimed to evaluate the clinical interventions and the degree of adherence to recommendations in outpatients of current COPD clinical practice guidelines.


METHODS
This is an observational study with prospective recruitment (May 2014-May 2015) of patients with a COPD diagnosis as seen in outpatient respiratory clinics. The information collected was historical in nature as for the clinical data of the last and previous consultations, and the information concerning hospital resources was concurrent.


RESULTS
A total of 17,893 clinical records of COPD patients in outpatient respiratory clinics from 59 Spanish hospitals were evaluated. Of the 5,726 patients selected, 4,508 (78.7%) were eligible. Overall, 12.1% of COPD patients did not fulfill a diagnostic spirometry criteria. Considerable variability existed in the available resources and work organization of the hospitals, although the majority were university hospitals with respiratory inpatient units. There was insufficient implementation of clinical guidelines in preventive and educational matters. In contrast, quantitative evaluation of dyspnea grade (81.9%) and exacerbation history (70.9%) were more frequently performed. Only 12.4% had COPD severity calculated according to the Body mass index, airflow Obstruction, Dyspnoea and Exercise capacity (BODE) index. Phenotype characteristics according to Spanish National Guideline for COPD were determined in 46.3% of the audited patients, and the risk evaluation according to Global initiative for chronic Obstructive Lung Disease was estimated only in 21.9%.


CONCLUSIONS
The EPOCONSUL study reports the current situation of medical care for COPD patients in outpatient clinics in Spain, revealing its variability, strengths, and weaknesses. This information has to be accounted for by health managers to define corrective strategies and maximize good clinical practice.
Pulmonary Department, Hospital Clínico San Carlos; Department of Medicine, Faculty of Medicine, University Complutense of Madrid; Research Institute of Hospital Clínico San Carlos (IdISSC), Madrid.
Myriam
M
Calle Rubio
Pulmonary Department, Hospital de Alta Resolución de Noja, Granada.
Bernardino
B
Alcázar Navarrete
Research Institute of Hospital University La Princesa (IISP), University Autónoma of Madrid.
Joan B
JB
Soriano
Pulmonary Department, Hospital de Arnau de Villanova, Valencia.
Juan J
JJ
Soler-Cataluña
Pulmonary Department, Hospital Universitario Principe de Asturias, Alcalá de Henares, Madrid.
José Miguel
JM
Rodríguez González-Moro
Department of Medicine, Faculty of Medicine, University Complutense of Madrid; Research Institute of Hospital Clínico San Carlos (IdISSC), Madrid; UGC of Preventive Medicine and Research Institute of Hospital Clínico San Carlos, Madrid.
Manuel E
ME
Fuentes Ferrer
Pulmonary Department, Hospital University Virgen del Rocio, Institute of Biomedicine of Sevilla (IBiS), Sevilla, Spain.
José Luis
JL
López-Campos
D000368:Aged; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000592:standards; D017079:Exercise Tolerance; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008168:Lung / Q000503:physiopathology; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000592:standards; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D017064:Process Assessment, Health Care / Q000592:standards; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D015272:Pulmonary Medicine; D000072106:Pulmonologists / Q000592:standards; D012017:Referral and Consultation; D012720:Severity of Illness Index; D013030:Spain; D016896:Treatment Outcome
adherence; chronic obstructive pulmonary disease; clinical audit; clinical guidelines; medical care