Quantification of inaccurate diagnosis of COPD in primary care medicine: an analysis of the COACH clinical audit

Abstract

María Abad-Arranz,1 Ana Moran-Rodríguez,2 Enrique Mascarós Balaguer,3 Carmen Quintana Velasco,4 Laura Abad Polo,5 Sara Núñez Palomo,6 Jaime Gonzálvez Rey,7 Ana María Fernández Vargas,8 Antonio Hidalgo Requena,9 Jose Manuel Helguera Quevedo,10 Marina García Pardo,11 Jose Luis Lopez-Campos on behalf of the COACH study investigators1,121Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain; 2UGC-DCCU Bahía de Cádiz-La Janda, Cádiz, Spain; 3Centro de Salud Fuente de San Luis, Valencia, Spain; 4Centro de Salud Perpetuo Socorro, Huesca, Spain; 5Centro de Salud Illueca, sector Calatayud, Zaragoza, Spain; 6Centro de Salud Torrelaguna, Madrid, Spain; 7Centro de Salud Matamá, Vigo, Spain; 8Centro de Salud La Victoria, Málaga, Spain; 9Centro de Salud de Lucena, Córdoba, Spain; 10Centro de Salud Bajo Asón, Ampuero, Cantabria, Spain; 11Centro de Salud de Inca, Mallorca, Spain; 12Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, SpainBackground: Inaccurate diagnosis in COPD is a current problem with relevant consequences in terms of inefficient health care, which has not been thoroughly studied in primary care medicine. The aim of the present study was to evaluate the degree of inaccurate diagnosis in Primary Care in Spain and study the determinants associated with it.Methods: The Community Assessment of COPD Health Care (COACH) study is a national, observational, randomized, non-interventional, national clinical audit aimed at evaluating clinical practice for patients with COPD in primary care medicine in Spain. For the present analysis, a correct diagnosis was evaluated based on previous exposure and airway obstruction with and without the presence of symptoms. The association of patient-level and center-level variables with inaccurate diagnosis was studied using multivariate multilevel binomial logistic regression models.Results: During the study 4,307 cases from 63 centers were audited. The rate of inaccurate diagnosis was 82.4% (inter-regional range from 76.8% to 90.2%). Patient-related interventions associated with inaccurate diagnosis were related to active smoking, lung function evaluation, and specific therapeutic interventions. Center-level variables related to the availability of certain complementary tests and different aspects of the resources available were also associated with an inaccurate diagnosis.Conclusions: The prevalence data for the inaccurate diagnosis of COPD in primary care medicine in Spain establishes a point of reference in the clinical management of COPD. The descriptors of the variables associated with this inaccurate diagnosis can be used to identify cases and centers in which inaccurate diagnosis is occurring considerably, thus allowing for improvement.Keywords: COPD, clinical audit, primary care medicine, inaccurate diagnosis

Keywords

• COPD
• clinical audit
• primary care medicine
• inaccurate diagnosis