Practice patterns in the management of chronic obstructive pulmonary disease in primary practice: the CAGE study.
Identifieur interne : 000D22 ( Main/Exploration ); précédent : 000D21; suivant : 000D23Practice patterns in the management of chronic obstructive pulmonary disease in primary practice: the CAGE study.
Auteurs : J. Bourbeau [Canada] ; R J Sebaldt ; A. Day ; J. Bouchard ; A. Kaplan ; P. Hernandez ; M. Rouleau ; A. Petrie ; G. Foster ; L. Thabane ; J. Haddon ; A. ScaleraSource :
- Canadian respiratory journal [ 1198-2241 ]
Descripteurs français
- KwdFr :
- Adulte d'âge moyen, Broncho-pneumopathie chronique obstructive (), Broncho-pneumopathie chronique obstructive (diagnostic), Bronchodilatateurs (usage thérapeutique), Canada, Femelle, Glucocorticoïdes (usage thérapeutique), Humains, Indice de gravité médicale, Mâle, Résultat thérapeutique, Soins de santé primaires, Spirométrie, Sujet âgé, Types de pratiques des médecins, Études transversales.
- MESH :
- diagnostic : Broncho-pneumopathie chronique obstructive.
- usage thérapeutique : Bronchodilatateurs, Glucocorticoïdes.
- Adulte d'âge moyen, Broncho-pneumopathie chronique obstructive, Canada, Femelle, Humains, Indice de gravité médicale, Mâle, Résultat thérapeutique, Soins de santé primaires, Spirométrie, Sujet âgé, Types de pratiques des médecins, Études transversales.
- Wicri :
- geographic : Canada.
English descriptors
- KwdEn :
- Aged, Bronchodilator Agents (therapeutic use), Canada, Cross-Sectional Studies, Female, Glucocorticoids (therapeutic use), Humans, Male, Middle Aged, Practice Patterns, Physicians', Primary Health Care, Pulmonary Disease, Chronic Obstructive (diagnosis), Pulmonary Disease, Chronic Obstructive (therapy), Severity of Illness Index, Spirometry, Treatment Outcome.
- MESH :
- chemical , therapeutic use : Bronchodilator Agents, Glucocorticoids.
- geographic : Canada.
- diagnosis : Pulmonary Disease, Chronic Obstructive.
- therapy : Pulmonary Disease, Chronic Obstructive.
- Aged, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Practice Patterns, Physicians', Primary Health Care, Severity of Illness Index, Spirometry, Treatment Outcome.
Abstract
BACKGROUND
The information on usual care for patients with chronic obstructive pulmonary disease (COPD) in primary care is limited in Canada.
OBJECTIVE
To evaluate primary care practice in patients with COPD in Quebec and Ontario compared with recommended care.
METHODS
The COPD Care Gap Evaluation (CAGE) was a prospective, cross-sectional study. Physicians' self-reported data of enrolled COPD patients were compared with the recommended care for the level of disease severity (using the Canadian Thoracic Society classification by symptoms) and stability, derived from Canadian Thoracic Society COPD guidelines. Pharmacological treatment, spirometric confirmation of diagnosis and nonpharmacological management, including smoking cessation counselling, influenza immunization and referral for pulmonary rehabilitation, were assessed.
RESULTS
Participating physicians (n=161; 44 in Quebec, 117 in Ontario) recruited 1090 patients (320 in Quebec, 770 in Ontario). The mean (+/- SD) age of the patients was 69.9+/-10.4 years; 60% were male and 40% were currently smoking. Pharmacological treatment that matched guideline recommendations was identified in 34% of patients. Discrepancies between reported and recommended treatment stemmed from nonprescription of long-acting bronchodilators (LABDs) for patients with moderate (27%) and severe (21%) COPD, nonprescription of two long-acting beta agonists (a beta(2)-agonist and an anticholinergic) for patients with severe COPD (51%), and prescription of inhaled corticosteroids (63%) and LABDs (47%) for patients with mild COPD for which the treatment is not recommended. Spirometric confirmation of diagnosis, as recommended by the guidelines, was reported in 56% of patients. For nonpharmacological management, smoking cessation counselling (95%) and influenza immunization (80%) were near optimal. Referral for pulmonary rehabilitation (9%) was not common. Differences between provinces were seen mainly in the prescription of short-acting bronchodilators (89% in Quebec, 76% in Ontario) and LABDs (60% in Quebec, 80% in Ontario).
CONCLUSIONS
Substantial gaps between recommended and current care exist in the management of COPD patients in primary care practice. Undertreatment of patients with severe COPD has potential clinical implications, including loss of autonomy and hospitalization.
DOI: 10.1155/2008/173904
PubMed: 18292848
Affiliations:
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Day</name></author><author><name sortKey="Bouchard, J" sort="Bouchard, J" uniqKey="Bouchard J" first="J" last="Bouchard">J. Bouchard</name></author><author><name sortKey="Kaplan, A" sort="Kaplan, A" uniqKey="Kaplan A" first="A" last="Kaplan">A. Kaplan</name></author><author><name sortKey="Hernandez, P" sort="Hernandez, P" uniqKey="Hernandez P" first="P" last="Hernandez">P. Hernandez</name></author><author><name sortKey="Rouleau, M" sort="Rouleau, M" uniqKey="Rouleau M" first="M" last="Rouleau">M. Rouleau</name></author><author><name sortKey="Petrie, A" sort="Petrie, A" uniqKey="Petrie A" first="A" last="Petrie">A. Petrie</name></author><author><name sortKey="Foster, G" sort="Foster, G" uniqKey="Foster G" first="G" last="Foster">G. Foster</name></author><author><name sortKey="Thabane, L" sort="Thabane, L" uniqKey="Thabane L" first="L" last="Thabane">L. Thabane</name></author><author><name sortKey="Haddon, J" sort="Haddon, J" uniqKey="Haddon J" first="J" last="Haddon">J. 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Bourbeau</name><affiliation wicri:level="3"><nlm:affiliation>Montreal Chest Institute, McGill University Health Center, Montreal, Canada. jean.bourbeau@mcgill.ca</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Montreal Chest Institute, McGill University Health Center, Montreal</wicri:regionArea><placeName><settlement type="city">Montréal</settlement><region type="state">Québec</region></placeName></affiliation></author><author><name sortKey="Sebaldt, R J" sort="Sebaldt, R J" uniqKey="Sebaldt R" first="R J" last="Sebaldt">R J Sebaldt</name></author><author><name sortKey="Day, A" sort="Day, A" uniqKey="Day A" first="A" last="Day">A. Day</name></author><author><name sortKey="Bouchard, J" sort="Bouchard, J" uniqKey="Bouchard J" first="J" last="Bouchard">J. Bouchard</name></author><author><name sortKey="Kaplan, A" sort="Kaplan, A" uniqKey="Kaplan A" first="A" last="Kaplan">A. Kaplan</name></author><author><name sortKey="Hernandez, P" sort="Hernandez, P" uniqKey="Hernandez P" first="P" last="Hernandez">P. Hernandez</name></author><author><name sortKey="Rouleau, M" sort="Rouleau, M" uniqKey="Rouleau M" first="M" last="Rouleau">M. Rouleau</name></author><author><name sortKey="Petrie, A" sort="Petrie, A" uniqKey="Petrie A" first="A" last="Petrie">A. Petrie</name></author><author><name sortKey="Foster, G" sort="Foster, G" uniqKey="Foster G" first="G" last="Foster">G. Foster</name></author><author><name sortKey="Thabane, L" sort="Thabane, L" uniqKey="Thabane L" first="L" last="Thabane">L. Thabane</name></author><author><name sortKey="Haddon, J" sort="Haddon, J" uniqKey="Haddon J" first="J" last="Haddon">J. Haddon</name></author><author><name sortKey="Scalera, A" sort="Scalera, A" uniqKey="Scalera A" first="A" last="Scalera">A. Scalera</name></author></analytic><series><title level="j">Canadian respiratory journal</title><idno type="ISSN">1198-2241</idno></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged</term><term>Bronchodilator Agents (therapeutic use)</term><term>Canada</term><term>Cross-Sectional Studies</term><term>Female</term><term>Glucocorticoids (therapeutic use)</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Practice Patterns, Physicians'</term><term>Primary Health Care</term><term>Pulmonary Disease, Chronic Obstructive (diagnosis)</term><term>Pulmonary Disease, Chronic Obstructive (therapy)</term><term>Severity of Illness Index</term><term>Spirometry</term><term>Treatment Outcome</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte d'âge moyen</term><term>Broncho-pneumopathie chronique obstructive ()</term><term>Broncho-pneumopathie chronique obstructive (diagnostic)</term><term>Bronchodilatateurs (usage thérapeutique)</term><term>Canada</term><term>Femelle</term><term>Glucocorticoïdes (usage thérapeutique)</term><term>Humains</term><term>Indice de gravité médicale</term><term>Mâle</term><term>Résultat thérapeutique</term><term>Soins de santé primaires</term><term>Spirométrie</term><term>Sujet âgé</term><term>Types de pratiques des médecins</term><term>Études transversales</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Bronchodilator Agents</term><term>Glucocorticoids</term></keywords><keywords scheme="MESH" type="geographic" xml:lang="en"><term>Canada</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Pulmonary Disease, Chronic Obstructive</term></keywords><keywords scheme="MESH" qualifier="diagnostic" xml:lang="fr"><term>Broncho-pneumopathie chronique obstructive</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Pulmonary Disease, Chronic Obstructive</term></keywords><keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Bronchodilatateurs</term><term>Glucocorticoïdes</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Cross-Sectional Studies</term><term>Female</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Practice Patterns, Physicians'</term><term>Primary Health Care</term><term>Severity of Illness Index</term><term>Spirometry</term><term>Treatment Outcome</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte d'âge moyen</term><term>Broncho-pneumopathie chronique obstructive</term><term>Canada</term><term>Femelle</term><term>Humains</term><term>Indice de gravité médicale</term><term>Mâle</term><term>Résultat thérapeutique</term><term>Soins de santé primaires</term><term>Spirométrie</term><term>Sujet âgé</term><term>Types de pratiques des médecins</term><term>Études transversales</term></keywords><keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>Canada</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>The information on usual care for patients with chronic obstructive pulmonary disease (COPD) in primary care is limited in Canada.</p></div><div type="abstract" xml:lang="en"><p><b>OBJECTIVE</b></p><p>To evaluate primary care practice in patients with COPD in Quebec and Ontario compared with recommended care.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>The COPD Care Gap Evaluation (CAGE) was a prospective, cross-sectional study. Physicians' self-reported data of enrolled COPD patients were compared with the recommended care for the level of disease severity (using the Canadian Thoracic Society classification by symptoms) and stability, derived from Canadian Thoracic Society COPD guidelines. Pharmacological treatment, spirometric confirmation of diagnosis and nonpharmacological management, including smoking cessation counselling, influenza immunization and referral for pulmonary rehabilitation, were assessed.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>Participating physicians (n=161; 44 in Quebec, 117 in Ontario) recruited 1090 patients (320 in Quebec, 770 in Ontario). The mean (+/- SD) age of the patients was 69.9+/-10.4 years; 60% were male and 40% were currently smoking. Pharmacological treatment that matched guideline recommendations was identified in 34% of patients. Discrepancies between reported and recommended treatment stemmed from nonprescription of long-acting bronchodilators (LABDs) for patients with moderate (27%) and severe (21%) COPD, nonprescription of two long-acting beta agonists (a beta(2)-agonist and an anticholinergic) for patients with severe COPD (51%), and prescription of inhaled corticosteroids (63%) and LABDs (47%) for patients with mild COPD for which the treatment is not recommended. Spirometric confirmation of diagnosis, as recommended by the guidelines, was reported in 56% of patients. For nonpharmacological management, smoking cessation counselling (95%) and influenza immunization (80%) were near optimal. Referral for pulmonary rehabilitation (9%) was not common. Differences between provinces were seen mainly in the prescription of short-acting bronchodilators (89% in Quebec, 76% in Ontario) and LABDs (60% in Quebec, 80% in Ontario).</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>Substantial gaps between recommended and current care exist in the management of COPD patients in primary care practice. Undertreatment of patients with severe COPD has potential clinical implications, including loss of autonomy and hospitalization.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">18292848</PMID><DateCompleted><Year>2008</Year><Month>06</Month><Day>17</Day></DateCompleted><DateRevised><Year>2019</Year><Month>12</Month><Day>10</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Print">1198-2241</ISSN><JournalIssue CitedMedium="Print"><Volume>15</Volume><Issue>1</Issue><PubDate><MedlineDate>2008 Jan-Feb</MedlineDate></PubDate></JournalIssue><Title>Canadian respiratory journal</Title><ISOAbbreviation>Can. Respir. J.</ISOAbbreviation></Journal><ArticleTitle>Practice patterns in the management of chronic obstructive pulmonary disease in primary practice: the CAGE study.</ArticleTitle><Pagination><MedlinePgn>13-9</MedlinePgn></Pagination><Abstract><AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">The information on usual care for patients with chronic obstructive pulmonary disease (COPD) in primary care is limited in Canada.</AbstractText><AbstractText Label="OBJECTIVE" NlmCategory="OBJECTIVE">To evaluate primary care practice in patients with COPD in Quebec and Ontario compared with recommended care.</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">The COPD Care Gap Evaluation (CAGE) was a prospective, cross-sectional study. Physicians' self-reported data of enrolled COPD patients were compared with the recommended care for the level of disease severity (using the Canadian Thoracic Society classification by symptoms) and stability, derived from Canadian Thoracic Society COPD guidelines. Pharmacological treatment, spirometric confirmation of diagnosis and nonpharmacological management, including smoking cessation counselling, influenza immunization and referral for pulmonary rehabilitation, were assessed.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">Participating physicians (n=161; 44 in Quebec, 117 in Ontario) recruited 1090 patients (320 in Quebec, 770 in Ontario). The mean (+/- SD) age of the patients was 69.9+/-10.4 years; 60% were male and 40% were currently smoking. Pharmacological treatment that matched guideline recommendations was identified in 34% of patients. Discrepancies between reported and recommended treatment stemmed from nonprescription of long-acting bronchodilators (LABDs) for patients with moderate (27%) and severe (21%) COPD, nonprescription of two long-acting beta agonists (a beta(2)-agonist and an anticholinergic) for patients with severe COPD (51%), and prescription of inhaled corticosteroids (63%) and LABDs (47%) for patients with mild COPD for which the treatment is not recommended. Spirometric confirmation of diagnosis, as recommended by the guidelines, was reported in 56% of patients. For nonpharmacological management, smoking cessation counselling (95%) and influenza immunization (80%) were near optimal. Referral for pulmonary rehabilitation (9%) was not common. Differences between provinces were seen mainly in the prescription of short-acting bronchodilators (89% in Quebec, 76% in Ontario) and LABDs (60% in Quebec, 80% in Ontario).</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">Substantial gaps between recommended and current care exist in the management of COPD patients in primary care practice. Undertreatment of patients with severe COPD has potential clinical implications, including loss of autonomy and hospitalization.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Bourbeau</LastName><ForeName>J</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Montreal Chest Institute, McGill University Health Center, Montreal, Canada. jean.bourbeau@mcgill.ca</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Sebaldt</LastName><ForeName>R J</ForeName><Initials>RJ</Initials></Author><Author ValidYN="Y"><LastName>Day</LastName><ForeName>A</ForeName><Initials>A</Initials></Author><Author ValidYN="Y"><LastName>Bouchard</LastName><ForeName>J</ForeName><Initials>J</Initials></Author><Author ValidYN="Y"><LastName>Kaplan</LastName><ForeName>A</ForeName><Initials>A</Initials></Author><Author ValidYN="Y"><LastName>Hernandez</LastName><ForeName>P</ForeName><Initials>P</Initials></Author><Author ValidYN="Y"><LastName>Rouleau</LastName><ForeName>M</ForeName><Initials>M</Initials></Author><Author ValidYN="Y"><LastName>Petrie</LastName><ForeName>A</ForeName><Initials>A</Initials></Author><Author ValidYN="Y"><LastName>Foster</LastName><ForeName>G</ForeName><Initials>G</Initials></Author><Author ValidYN="Y"><LastName>Thabane</LastName><ForeName>L</ForeName><Initials>L</Initials></Author><Author ValidYN="Y"><LastName>Haddon</LastName><ForeName>J</ForeName><Initials>J</Initials></Author><Author ValidYN="Y"><LastName>Scalera</LastName><ForeName>A</ForeName><Initials>A</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D003160">Comparative Study</PublicationType><PublicationType UI="D023362">Evaluation Study</PublicationType><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>Egypt</Country><MedlineTA>Can Respir J</MedlineTA><NlmUniqueID>9433332</NlmUniqueID><ISSNLinking>1198-2241</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D001993">Bronchodilator Agents</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D005938">Glucocorticoids</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D001993" MajorTopicYN="N">Bronchodilator Agents</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D002170" MajorTopicYN="N" Type="Geographic">Canada</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D003430" MajorTopicYN="N">Cross-Sectional Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005938" MajorTopicYN="N">Glucocorticoids</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D010818" MajorTopicYN="Y">Practice Patterns, Physicians'</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011320" MajorTopicYN="N">Primary Health Care</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D029424" MajorTopicYN="N">Pulmonary Disease, Chronic Obstructive</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="Y">diagnosis</QualifierName><QualifierName UI="Q000628" MajorTopicYN="Y">therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D012720" MajorTopicYN="N">Severity of Illness Index</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D013147" MajorTopicYN="N">Spirometry</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016896" MajorTopicYN="N">Treatment Outcome</DescriptorName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="pubmed"><Year>2008</Year><Month>2</Month><Day>23</Day><Hour>9</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2008</Year><Month>6</Month><Day>18</Day><Hour>9</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2008</Year><Month>2</Month><Day>23</Day><Hour>9</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId 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Bouchard</name><name sortKey="Day, A" sort="Day, A" uniqKey="Day A" first="A" last="Day">A. Day</name><name sortKey="Foster, G" sort="Foster, G" uniqKey="Foster G" first="G" last="Foster">G. Foster</name><name sortKey="Haddon, J" sort="Haddon, J" uniqKey="Haddon J" first="J" last="Haddon">J. Haddon</name><name sortKey="Hernandez, P" sort="Hernandez, P" uniqKey="Hernandez P" first="P" last="Hernandez">P. Hernandez</name><name sortKey="Kaplan, A" sort="Kaplan, A" uniqKey="Kaplan A" first="A" last="Kaplan">A. Kaplan</name><name sortKey="Petrie, A" sort="Petrie, A" uniqKey="Petrie A" first="A" last="Petrie">A. Petrie</name><name sortKey="Rouleau, M" sort="Rouleau, M" uniqKey="Rouleau M" first="M" last="Rouleau">M. Rouleau</name><name sortKey="Scalera, A" sort="Scalera, A" uniqKey="Scalera A" first="A" last="Scalera">A. Scalera</name><name sortKey="Sebaldt, R J" sort="Sebaldt, R J" uniqKey="Sebaldt R" first="R J" last="Sebaldt">R J Sebaldt</name><name sortKey="Thabane, L" sort="Thabane, L" uniqKey="Thabane L" first="L" last="Thabane">L. Thabane</name></noCountry><country name="Canada"><region name="Québec"><name sortKey="Bourbeau, J" sort="Bourbeau, J" uniqKey="Bourbeau J" first="J" last="Bourbeau">J. Bourbeau</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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|texte= Practice patterns in the management of chronic obstructive pulmonary disease in primary practice: the CAGE study.
}}
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