Results of the CAPPS: COPD – Assessment of Practice in Primary Care Study

Abstract

Objective:

Since many patients with COPD in the US are managed by primary care physicians, we evaluated adherence to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines in a primary care setting.

Methods:

A cross-sectional study was conducted using a random sample of patients (n = 50–150 per site) aged 40–89 years with diagnosed COPD. Patients were identified for study inclusion (N = 1517) from 11 US primary care sites. Demographic and clinical information was extracted from primary care medical records via retrospective chart review. The main outcome measures were adherence to GOLD primary care guidelines, assessed via three components as follows: 1. Is there a current diagnostic spirometry test measurement available within the patient’s medical record during the prior calendar year? 2. Are comorbid conditions, if present, being treated appropriately? 3. Are adequate risk reduction measures being taken?

Results:

Mean patient age was 67.2 (SD ± 11.3) years, 54% were female, and 34% were current smokers. Overall, 19% of patients had comorbid asthma, 66% hypertension, 61% dyslipidemia, 30% cardiovascular disease, and 28% diabetes. Mean duration of COPD was approximately 4.8 years. Only 27% of patients had a spirometry test result documented within the past year. More than half (52%) of patients did not have a documented COPD stage; 20% were classified as stage I, 13% stage II, 12% stage III, 3% stage IV. About 63% of patients met at least one guideline component, while only 3% of patients met all components; 27% met diagnostic, 25% comorbid conditions management, and 32% met risk reduction criteria.

Limitations:

The retrospective design of our study did not allow evaluation of some possible covariates or causal assessment, and spirometry measurements were unavailable for many patients.

Conclusions:

Results suggest that treatment per COPD primary care guidelines was not consistently applied among participating practices (range 0.0%–8.7% for meeting all three components). Educational initiatives may increase primary care providers’ knowledge of and adherence to COPD treatment guidelines and recommended patient management strategies.

Keywords::

• Chronic disease management
• Chronic obstructive pulmonary disease (COPD)
• Guideline adherence
• Primary care

Transparency

Declaration of funding

This study was funded by Novartis Pharmaceuticals Corporation. D.B. and C.Z., who were employees of Novartis at the time of the study, were involved in study design, interpretation of the study findings, drafting and editing the manuscript, and approval of the final version of the manuscript.

Declaration of financial/other relationships

C.Z. is employed by Novartis Pharmaceuticals Corporation, the study sponsor, and reports Novartis stock and stock option ownership. D.B. was employed by Novartis Pharmaceuticals Corporation at the time of the study. J.W. and J.L. were compensated by Novartis Pharmaceuticals Corporation for their roles in supporting the study and manuscript preparation.

CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.

Acknowledgements

The authors would like to thank Dr. David Mannino MD and Dr. Sidney Braman for assistance with study development and design.

Portions of this study were presented at the Academy Health Annual Research Meeting, COPD Management and Guideline Adherence in a Primary Care Setting – Poster Session B, Monday 25 June 2012.