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Published on: August 24, 2019
A snapshot of chronic obstructive pulmonary disease management in general practice in Ireland
Liam O'Halloran1, Amy Purcell2, Eoin Ryan2
1Mid-West Specialist Training Programme in General Practice, University of Limerick, Plassey, Limerick, Ireland. liamoh@gmail.com.
Insights
This study assessed Chronic Obstructive Pulmonary Disease (COPD) care in Irish general practice against GOLD guidelines. Management showed gaps in diagnosis, staging, and therapy, though smoking cessation advice and vaccinations were partially implemented.
Area of Science:
- Pulmonary Medicine
- General Practice
- Healthcare Quality Improvement
Background:
- Chronic Obstructive Pulmonary Disease (COPD) presents complex diagnostic and management challenges.
- There is limited data on COPD care standards within Irish general practice.
- This study addresses the need for data on COPD management in this setting.
Purpose of the Study:
- To evaluate COPD diagnosis and management against Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines.
- To assess the provision of smoking cessation advice to patients with COPD.
- To determine the uptake of influenza and pneumococcal vaccinations in COPD patients.
Main Methods:
- A data-collection audit tool based on GOLD 2019 guidelines was used.
- Ten general practices in the Irish Mid-West Specialist Training Programme were audited.
- Descriptive statistics were employed to analyze data from 482 COPD patients.
Main Results:
- Appropriate COPD diagnosis was present in 49.4% of patients; staging was formally assessed in only 56.2%.
- 33.2% received appropriate therapy, while 71% of eligible smokers received cessation advice.
- Influenza vaccination was given to 66.2% and pneumococcal vaccination to 53.9% of patients.
Conclusions:
- The study offers a detailed overview of COPD patient care in Irish general practice before the Chronic Disease Management program.
- Findings highlight areas for improvement in COPD diagnosis, staging, and treatment adherence.
- The results provide a baseline for future quality improvement initiatives in COPD management.
Background:
Chronic obstructive pulmonary disease (COPD) is a leading cause of death and disability. Its diagnosis, classification and management are complex. There is a paucity of data on the standard of COPD management in Irish general practice.
Aims:
We studied whether COPD diagnosis and management was in accordance with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. We investigated if patients who were smokers had received smoking cessation advice. We examined whether influenza and pneumococcal vaccination had been given.
Methods:
Ten general practices affiliated with the Irish Mid-West Specialist Training Programme in General Practice (GP) were searched, to determine which patients had a diagnosis of COPD. A data-collection audit tool was developed using GOLD 2019 guidelines. Results were tabulated in SPSS. Descriptive statistics were used.
Results:
Of 482 patients studied, 91.7% were eligible for free GP care. In 49.4%, the diagnosis of COPD had been made appropriately. In 56.2%, there was no evidence that the stage of COPD had been formally assessed. Of the patients studied, 33.2% were deemed to be receiving appropriate therapy. Smoking status was documented in 99.6% of cases studied and 59.9% were ex-smokers, while 25.9% were current smokers. Appropriate smoking cessation advice had been offered to 71% of eligible patients. Influenza vaccine had been given to 66.2% in the previous 12 months. A total of 53.9% had ever received pneumococcal vaccination.
Conclusions:
This study provides a comprehensive snapshot of care in Irish general practice for patients with COPD prior to introduction of the Chronic Disease Management programme (CDM).
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