Adherence to GOLD guidelines in real-life COPD management in the Puglia region of Italy
Rattachement africain : it. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
Background: COPD is a disease associated with significant economic burden. It was reported that Global initiative for chronic Obstructive Lung Disease (GOLD) guideline-oriented pharmacotherapy improves airflow limitation and reduces health care costs. However, several studies showed a significant dissociation between international recommendations and clinicians' practices. The consequent reduced diagnostic and therapeutic inappropriateness has proved to be associated with an increase in costs and a waste of economic resources in the health sector. The aim of the study was to evaluate COPD management in the Puglia region. The study was performed in collaboration with the pulmonology centers and the Regional Health Agency (AReS Puglia). Methods: An IT platform allowed the pulmonologists to enter data via the Internet. All COPD patients who visited a pneumological outpatient clinic for the first time or for regular follow-ups or were admitted to a pneumological department for an exacerbation were considered eligible for the study. COPD's diagnosis was confirmed by a pulmonologist at the moment of the visit. The project lasted 18 months and involved 17 centers located in the Puglia region. Results: Six hundred ninety-three patients were enrolled, evenly distributed throughout the region. The mean age was 71±9 years, and 85% of them were males. Approximately 23% were current smokers, 63% former smokers and 13.5% never smokers. The mean post-bronchodilator forced expiratory volume in 1 second was 59%±20% predicted. The platform allowed the classification of patients according to the GOLD guidelines (Group A: 20.6%, Group B: 32.3%, Group C: 5.9% and Group D: 39.2%), assessed the presence and severity of exacerbations (20% of the patients had an exacerbation defined as mild [13%], moderate [37%] and severe [49%]) and evaluated the appropriateness of inhalation therapy at the time of the visit. Forty-nine percent of Group A patients were following inappropriate therapy; in Group B, 45.8% were following a therapy in contrast with the guidelines. Among Group C patients, 41.46% resulted in triple combination therapy, whilê14% of Group D patients did not have a therapy or were following an inappropriate therapy. In conclusion, 30% of all patients evaluated had been following an inadequate therapy. Subsequently, an online survey was developed to inquire about the reasons for the results obtained. In particular, we investigated the reasons why 30% of our population did not follow the therapy suggested by the GOLD guidelines: 1) why was there an excessive use of inhaled corticosteroids, 2) why a significantly high percentage was inappropriately treated with triple therapy and 3) why a consistent percentage (11%) of Group D patients were not treated at all. Conclusion: The data provides an overview on the management of COPD in the region of Puglia (Italy) and represents a resource in order to improve appropriateness and reduce the waste of health resources.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Adherence to GOLD guidelines in real-life COPD management in the Puglia region of Italy
- Date Crossref
- 01/08/2018
- Éditeur
- Informa UK Limited
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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University of Foggia Department of Medical and Surgical Sciences pays non établi dans la noticeUniversité ou école supérieure
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University of Bari Aldo Moro pays non établi dans la noticeUniversité ou école supérieure
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Ospedale Generale Regionale Francesco Miulli pays non établi dans la noticeÉtablissement de santé
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Ospedale Vito Fazzi pays non établi dans la noticeÉtablissement de santé
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Ospedale San Pietro Fatebenefratelli pays non établi dans la noticeÉtablissement de santé
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Fondazione Salvatore Maugeri pays non établi dans la noticeOrganisation à but non lucratif
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IRCCS San Camillo Hospital pays non établi dans la noticeÉtablissement de santé
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Ospedale Madonna Delle Grazie pays non établi dans la noticeÉtablissement de santé
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Agenzia Regionale per la Protezione Ambientale del Piemonte pays non établi dans la noticeOrganisme public
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Agenzia Regionale Sanitaria della Puglia pays non établi dans la noticeOrganisme public
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School of Medicine Department of Cardiac pays non établi dans la noticeUniversité ou école supérieure
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F Miulli General Hospital Physiopathology Respiratory Unit pays non établi dans la noticeÉtablissement de santé
Department of Medical and Surgical Sciences — University of Foggia, University of Bari Aldo Moro et Ospedale Generale Regionale Francesco Miulli, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.