Volume 16 Issue 3 June 2007
| Original Research |
The quality of COPD care in general practice in Denmark: the KVASIMODO Study
Pages 174-181
*Peter Langea, Finn Vejlø Rasmussenb, Hanne Borgeskovc, Jens Dollerupd, Michael Skov Jensene, Klaus Roslindf, Lill Moll Nielseng, on behalf of the KVASIMODO study groupZ
a Head Physician, Department of Cardiology and Respiratory Medicine, Hvidovre Hospital, Denmark
b Head Physician, Medical Department B, Hillerød Hospital, Denmark
c Medical Advisor, Boehringer Ingelheim, Copenhagen, Denmark
d Senior Medical Advisor, Pfizer, Ballerup, Denmark
e Head Physician, Medical Department, Skive Hospital, Denmark
f General Practitioner, Aarup, Denmark
g General Practitioner, Søborg, Denmark
Received 16 September 2006 • Accepted 24 February 2007 • Online 21 May 2007
Abstract
AIM: We studied the quality of care for COPD patients in a large sample of general practices in Denmark. We focussed on whether participation by general practitioners (GPs) in an educational programme could enhance the use of spirometry in the diagnosis and staging of the disease and improve adherence to COPD guidelines. METHODS: We performed two audit surveys of GPs’ patients’ notes, one year apart, before and after an educational programme for participating GPs and their staff. A total of 154 GPs participated in the study. 2549 patient records were included in the first survey and
2394 in the second. RESULTS: Based on analysis of all patient records, we observed a substantial improvement in the quality of care: recording of FEV1 improved from 52.7% of cases in the first survey to 71.4% in the second (p< 0.001). There was a significant improvement in the recording of body mass index and provision of smoking cessation advice, recommendation of physical activity, checking of inhalation technique, dietary instruction, and referral to pulmonary rehabilitation. We also found a decline in the use of inhaled corticosteroids in patients with mild COPD, from 60.2% in the first survey to 48.8% in the second. When analysing the results focussing on the performance of single GPs there was an improvement in quality, but this was less than the improvement for patients overall – suggesting that improvement in quality of care was not equally distributed throughout the GPs’ practices. CONCLUSION: We conclude that it is possible to improve the quality of COPD care by educating GPs and their staff.
Cite as: Lange P, Rasmussen FV, Borgeskov H, Dollerup J, Jensen MS, Roslind K, Nielsen LM, on behalf of the KVASIMODO study group. The quality of COPD care in general practice in Denmark: the KVASIMODO Study. Prim Care Respir J 2007;16(3):174-181. DOI: http://dx.doi.org/10.3132/pcrj.2007.00030
Keywords
COPD, general practice, quality of care, postgraduate education, audit, spirometry, diagnosis
* Corresponding author. Peter Lange Tel: (45) 36 32 32 37 Fax: (45) 36 32 37 84 Email: peter.lange@hh.hosp.dk