Changes in management of chronic obstructive pulmonary disease (COPD) in primary care: EMMEPOC study

Abstract

Background: Changes in management of COPD in primary care were studied following a training exercise among Spanish general practitioners (GPs). The exercise involved dissemination of the Spanish Society for Pulmonology and Thoracic Surgery (SEPAR) guidelines. The use of a portable device to perform spirometry tests was evaluated to adequately categorize COPD and reduce other diagnostic interventions.

Methods: A representative sample of GPs from general practices in Spain was recruited for the study. In phase I, GPs performed an initial evaluation of 5 patients with COPD. In phase II, GPs were randomly allocated to the following groups: 1) control group-G1 (GPs managing COPD according to usual clinical practice); 2) training group-G2 (dissemination of SEPAR guidelines); and 3) training group-G3 (dissemination of SEPAR guidelines and distribution of the Koko Peak Pro to measure FEV(1), FEV(6), and FEV(1)/FEV(6)).

Results: Phase-I included 3254 physicians, who selected 16,024 patients. In phase II, 301 physicians in G1, 1182 in G2, and 1141 in G3 selected 1481, 5798, and 5556 patients respectively. Evaluation of the changes in COPD stratification according to the SEPAR guidelines showed that physicians in G1 adequately classified 60% of patients, compared to 69% in G2 and 88.5% in G3 (p<0.0001). On comparing groups G1 and G3, a significant reduction was seen in chest X-rays (from 42% to 32%, p=0.0002) and arterial blood gas studies performed (from 34% to 22%, p<0.0001).

Conclusions: The dissemination of the SEPAR guidelines and the utilization of the portable device for spirometry may improve management of COPD in primary care.