A case scenario study for the assessment of physician’s behavior in the management of COPD: the WHY study

Figures & data

Table 1 Details of seven case scenarios

Case scenarios	Similar history and findings					Case ACOS	Case OHS
	Case GOLD A-smoker	Case GOLD A-nonsmoker	Case GOLD D-smoker	Case GOLD B-exsmoker	Case GOLD B-smoker
Scenario prepared by steering committee
Age (years)	38	63	57	54	61	47	79
Gender	Female	Female	Female	Male	Male	Male	Female
Smoking history	Current smoker	Never smoked	Current smoker	Quitted	Current smoker	Quitted	Passive smoker
	20 pack-years	NA	40 pack-years	40 pack-years	45 pack-years	28 pack-years	NA
Comorbidity	None	None	None	None	Diabetes + Hypertension	None	None
Cancer	None	None	None	None	None	None	None
Presenting with	Breathlessness	Breathlessness	Exacerbation	Exacerbation	Breathlessness	ACOS	OHS
FEV (%)	55	55	55	55	55	55	40
FEV1/FVC (%)	69	69	69	69	69	65	88
Previous diagnosis	Undiagnosed	Undiagnosed	COPD	COPD	COPD	Asthma-like history	COPD
Time since diagnosis	NA	NA	7 years	7 years	7 years	Intermittent symptoms	10 years
Hospitalization during the preceding year	NA	NA	Once due to COPD	Once due to COPD	Once due to COPD	None	Once due to COPD
Treatment	NA	NA	LABA and LAMA and ICS	LABA and LAMA and ICS	LABA and LAMA and ICS	LABA and ICS	LABA and LAMA and ICS
Treatment compliance	NA	NA	Compliance ±a	Compliance ±a	Compliance ±a	Compliance -b	Compliance ±a
Guideline-concordant diagnosis (not indicated in case scenario)	COPD	COPD	COPD	COPD	COPD	ACOSa	OHSb
GOLD category (not indicated in case scenario)	GOLD group A	GOLD group A	GOLD group D	GOLD group B	GOLD group B	NA	NA

Notes:

a Compliance ± means that the patient was not taking his/her medications regularly.

b Compliance - means that the patients were taking his/her medications occasionally.

Abbreviations: ACOS, asthma–COPD overlap syndrome; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; GOLD, Global Initiative for Chronic Obstructive Lung Disease; ICS, inhaled corticosteroids; LABA, long-acting β2 agonists; LAMA, long-acting muscarinic antagonists; OHS, obesity hypoventilation syndrome; NA, not applicable.

Table 2 Features of the physicians

Features
Gender
Female	34 (68.0)
Male	16 (32.0)
Number of years working as a specialist	7.0 (1.0–33.0)
Number of physicians working as a specialist for
≤10 years	32 (65.3)
>10 years	17 (34.7)
Working place
Tertiary health care center	31 (62.0)
Secondary health care center	19 (38.0)
Number of patients examined daily	40.0 (8.0–90.0)
Workload of physicians
≥40 patient examinations per day	25 (52.1)
<40 patient examinations per day	23 (47.9)
Performing PFT in the institutions	50 (100.0)

Note: Data are presented as n (%) or median (minimum–maximum), where appropriate.

Abbreviation: PFT, pulmonary function test.

Table 3 Summary of the results for each case

Case scenarios	Similar history and findings					Case ACOS	Case OHS
	Case GOLD A-smoker	Case GOLD A-nonsmoker	Case GOLD D-smoker	Case GOLD B-exsmoker	Case GOLD B-smoker
Features of the cases	Female, young	Female, older	Female, middle age	Male, middle age	Male, older	Male, younger	Female, elder, passive smoker
Decision
Guideline-concordant diagnosisa	44% of the physicians	74% of the physicians	91% of the physicians	93% of the physicians	96% of the physicians	30% of the physicians	16% of the physicians
Guideline-concordant treatment (% of total 50 physicians)	20% of the physicians	46% of the physicians	84% of the physicians	20% of the physicians	18% of the physicians	24% of the physicians	NA
Stepping approach to physicians’ decision process
Assessment with acceptable PFT	43/50 (86%)	43/50 (86%)	43/50 (86%)	43/50 (86%)	43/50 (86%)	NA	NA
Guideline-concordant diagnosis (% of the physicians who used appropriate PFT)a	19/43 (38%)	37/43 (74%)	39/43 (78%)	40/43 (80%)	41/43 (82%)	NA	NA
Categorization of the case according to GOLD groups (% of patients who were concordantly diagnosed)	5/19 (10%)	10/37 (20%)	9/39 (18%)	12/40 (24%)	11/41 (22%)	NA	NA
Making correct categorization/grouping	2/5 (4%)	3/10 (6%)	2/9 (4%)	2/12 (4%)	1/11 (2%)	NA	NA
Guideline-concordant treatment	2/2 (4%)	3/3 (6%)	2/2 (4%)	1/2 (2%)	1/1 (2%)	NA	NA
Follow-up	2 (4%)	1 (2%)	1 (2%)	1 (2%)	1 (2%)	NA	NA
Recommendations	4 (8%)	3 (6%)	4 (8%)	1 (2%)	2 (4%)	NA	NA

Note:

a The two rates may not be similar, as some physicians made a diagnosis with clinical findings only and did not use a correctly performed spirometry.

Abbreviations: ACOS, asthma–COPD overlap syndrome; GOLD, Global Initiative for Chronic Obstructive Lung Disease; OHS, obesity hypoventilation syndrome; PFT, pulmonary function test.

Figure 1 Rate of guideline-concordant diagnosis and treatment decisions of the physicians according to case scenarios.

Abbreviations: ACOS, asthma–COPD overlap syndrome; GOLD, Global Initiative for Chronic Obstructive Lung Disease.