Determinants of medical prescriptions for COPD care: an analysis of the EPOCONSUL clinical audit

Abstract

Jose Luis Lopez-Campos,1,2 Bernardino Alcázar Navarrete,3 Joan B Soriano,4 Juan J Soler-Cataluña,5 José Miguel Rodríguez González-Moro,6 Manuel E Fuentes Ferrer,7–9 Myriam Calle Rubio7,8,10 On behalf of the EPOCONSUL study group 1Medical-Surgical Unit of Respiratory Diseases, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain; 2CIBER of Respiratory Diseases, Instituto de Salud Carlos III, Madrid, Spain; 3Pneumology Department, Hospital de Alta Resolución de Loja, Granada, Spain; 4Research Institute, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain; 5Pneumology Department, Hospital de Arnau de Villanova-Lliria, Valencia, Spain; 6Pneumology Department, Hospital Universitario Príncipe de Asturias, Madrid, Spain; 7Department of Medicine, Faculty of Medicine, University Complutense of Madrid, Madrid, Spain; 8Research Unit, Instituto de Investigación del Hospital Clínico San Carlos, Madrid, Spain; 9Clinical Management Unit, Preventive Medicine and Research Institute of Hospital Clínico San Carlos, Madrid, Spain; 10Pneumology Department, Hospital Clínico San Carlos, Madrid, Spain Purpose: Current COPD management recommendations indicate that pharmacological treatment can be stepped up or down, but there are no recommendations on how to make this adjustment. We aimed to describe pharmacological prescriptions during a routine clinical visit for COPD and study the determinants of changing therapy. Methods: EPOCONSUL is a Spanish nationwide observational cross-sectional clinical audit with prospective case recruitment including 4,508 COPD patients from outpatient respiratory clinics for a period of 12 months (May 2014–May 2015). Prescription patterns were examined in 4,448 cases and changes analyzed in stepwise backward, binomial, multivariate, logistic regression models. Results: Patterns of prescription of inhaled therapy groups were no treatment prescribed, 124 (2.8%) cases; one or two long-acting bronchodilators (LABDs) alone, 1,502 (34.6%) cases; LABD with inhaled corticosteroids (ICSs), 389 (8.6%) cases; and triple therapy cases, 2,428 (53.9%) cases. Incorrect prescriptions of inhaled therapies were observed in 261 (5.9%) cases. After the clinical visit was audited, 3,494 (77.5%) cases did not modify their therapeutic prescription, 307 (6.8%) cases had a step up, 238 (5.3%) cases had a change for a similar scheme, 182 (4.1%) cases had a step down, and 227 (5.1%) cases had other nonspecified change. Stepping-up strategies were associated with clinical presentation (chronic bronchitis, asthma-like symptoms, and exacerbations), a positive bronchodilator test, and specific inhaled medication groups. Stepping down was associated with lung function impairment, ICS containing regimens, and nonexacerbator phenotype. Conclusion: The EPOCONSUL study shows a comprehensive evaluation of pharmacological treatments in COPD care, highlighting strengths and weaknesses, to help us understand how physicians use available drugs. Keywords: COPD, clinical audit, pharmacological prescriptions, quality of care

Keywords

• COPD
• clinical audit
• pharmacological prescriptions
• quality of care