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

Abstract

Background: 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

Acknowledgments

The coordinators of the project are grateful to all the local investigators in each participating PCC for the hard work and implication in gathering data with enthusiasm and dedication. This project has been possible with the collaboration of an unrestricted grant from Boehringer Ingelheim.

Disclosure

Dr Enrique Mascarós Balaguer reports personal fees from Pfizer, personal fees from GSK, personal fees from Novartis, grants and personal fees from GRAP, personal fees from semFYC, personal fees from SEPAR, personal fees from Chiesi, personal fees from AstraZeneca, personal fees from TEVA, personal fees from Live-Med Spain, personal fees from Orion, and personal fees from Bial, outside the submitted work. Dr Jaime Gonzálvez Rey reports personal fees from Boehringer Ingelheim, personal fees from ROVI, personal fees from AstraZeneca, personal fees from GSK, personal fees from GRAP, personal fees from 1aria, personal fees from semFYC, personal fees from SEMG, personal fees from Novartis, personal fees from Fundación Colegio Médico Pontevedra, non-financial support from Separ, grants from IPCRG, grants from ISCIII, and grants from Pfizer, outside the submitted work. Dr Antonio Hidalgo Requena reports personal fees from Esteve, personal fees from AstraZeneca, personal fees from GSK, personal fees from Boehringer Inguelheim, personal fees from Menarini, personal fees from Novartis, personal fees from Pfeizer, personal fees from Mundifarma, personal fees from Teva, and personal fees from Rovi, outside the submitted work. Dr Jose Manuel Helguera Quevedo reports personal fees from GSK, non-financial support from Zambon, personal fees from Mundipharma, and personal fees from Novartis, outside the submitted work. Dr Jose Luis Lopez-Campos reports grants, personal fees, non-financial support from Boehringer, grants, personal fees, non-financial support from Novartis, grants and personal fees from AstraZeneca, grants and personal fees from Chiesi, personal fees from Esteve, personal fees from Ferrer, grants and personal fees from GSK, grants, personal fees and non-financial support from Grifols, grants, personal fees and non-financial support from Menarini, and personal fees and non-financial support from Rovi, during the conduct of the study. The authors report no other conflicts of interest in this work.