Adherence to GOLD guidelines in real-life COPD management in the Puglia region of Italy

Giuseppe Antonio Palmiotti, Donato Lacedonia, Vito Liotino, Pietro Schino, Francesco Satriano, Pier Luigi Di Napoli, Eugenio Sabato, Vincenzo Mastrosimone, Alfredo Scoditti, Mauro Carone, Elio Costantino, Emanuela Resta, Ettore Attolini, Maria Pia Foschino Barbaro

Research output: Contribution to journalArticle

Abstract

Background: COPD is a disease associated with significant economic burden. It was reported that Global initiative for chronic Obstructive Lung Disease (GOLD) guideline-oriented pharmacotherapy improves airflow limitation and reduces health care costs. However, several studies showed a significant dissociation between international recommendations and clinicians' practices. The consequent reduced diagnostic and therapeutic inappropriateness has proved to be associated with an increase in costs and a waste of economic resources in the health sector. The aim of the study was to evaluate COPD management in the Puglia region. The study was performed in collaboration with the pulmonology centers and the Regional Health Agency (AReS Puglia).

Methods: An IT platform allowed the pulmonologists to enter data via the Internet. All COPD patients who visited a pneumological outpatient clinic for the first time or for regular follow-ups or were admitted to a pneumological department for an exacerbation were considered eligible for the study. COPD's diagnosis was confirmed by a pulmonologist at the moment of the visit. The project lasted 18 months and involved 17 centers located in the Puglia region.

Results: Six hundred ninety-three patients were enrolled, evenly distributed throughout the region. The mean age was 71±9 years, and 85% of them were males. Approximately 23% were current smokers, 63% former smokers and 13.5% never smokers. The mean post-bronchodilator forced expiratory volume in 1 second was 59%±20% predicted. The platform allowed the classification of patients according to the GOLD guidelines (Group A: 20.6%, Group B: 32.3%, Group C: 5.9% and Group D: 39.2%), assessed the presence and severity of exacerbations (20% of the patients had an exacerbation defined as mild [13%], moderate [37%] and severe [49%]) and evaluated the appropriateness of inhalation therapy at the time of the visit. Forty-nine percent of Group A patients were following inappropriate therapy; in Group B, 45.8% were following a therapy in contrast with the guidelines. Among Group C patients, 41.46% resulted in triple combination therapy, whilê14% of Group D patients did not have a therapy or were following an inappropriate therapy. In conclusion, 30% of all patients evaluated had been following an inadequate therapy. Subsequently, an online survey was developed to inquire about the reasons for the results obtained. In particular, we investigated the reasons why 30% of our population did not follow the therapy suggested by the GOLD guidelines: 1) why was there an excessive use of inhaled corticosteroids, 2) why a significantly high percentage was inappropriately treated with triple therapy and 3) why a consistent percentage (11%) of Group D patients were not treated at all.

Conclusion: The data provides an overview on the management of COPD in the region of Puglia (Italy) and represents a resource in order to improve appropriateness and reduce the waste of health resources.

Original languageEnglish
Pages (from-to)2455-2462
Number of pages8
JournalInternational Journal of COPD
Volume13
DOIs
Publication statusPublished - 2018

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Chronic Obstructive Pulmonary Disease
Italy
Guidelines
Health Resources
Therapeutics
Economics
Respiratory Therapy
Pulmonary Medicine
Bronchodilator Agents
Forced Expiratory Volume
Group Psychotherapy
Ambulatory Care Facilities
Health Care Costs
Internet
Adrenal Cortex Hormones
Costs and Cost Analysis
Drug Therapy
Health
Population

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Palmiotti, G. A., Lacedonia, D., Liotino, V., Schino, P., Satriano, F., Di Napoli, P. L., ... Foschino Barbaro, M. P. (2018). Adherence to GOLD guidelines in real-life COPD management in the Puglia region of Italy. International Journal of COPD, 13, 2455-2462. https://doi.org/10.2147/COPD.S157779

Adherence to GOLD guidelines in real-life COPD management in the Puglia region of Italy. / Palmiotti, Giuseppe Antonio; Lacedonia, Donato; Liotino, Vito; Schino, Pietro; Satriano, Francesco; Di Napoli, Pier Luigi; Sabato, Eugenio; Mastrosimone, Vincenzo; Scoditti, Alfredo; Carone, Mauro; Costantino, Elio; Resta, Emanuela; Attolini, Ettore; Foschino Barbaro, Maria Pia.

In: International Journal of COPD, Vol. 13, 2018, p. 2455-2462.

Research output: Contribution to journalArticle

Palmiotti, GA, Lacedonia, D, Liotino, V, Schino, P, Satriano, F, Di Napoli, PL, Sabato, E, Mastrosimone, V, Scoditti, A, Carone, M, Costantino, E, Resta, E, Attolini, E & Foschino Barbaro, MP 2018, 'Adherence to GOLD guidelines in real-life COPD management in the Puglia region of Italy', International Journal of COPD, vol. 13, pp. 2455-2462. https://doi.org/10.2147/COPD.S157779
Palmiotti GA, Lacedonia D, Liotino V, Schino P, Satriano F, Di Napoli PL et al. Adherence to GOLD guidelines in real-life COPD management in the Puglia region of Italy. International Journal of COPD. 2018;13:2455-2462. https://doi.org/10.2147/COPD.S157779
Palmiotti, Giuseppe Antonio ; Lacedonia, Donato ; Liotino, Vito ; Schino, Pietro ; Satriano, Francesco ; Di Napoli, Pier Luigi ; Sabato, Eugenio ; Mastrosimone, Vincenzo ; Scoditti, Alfredo ; Carone, Mauro ; Costantino, Elio ; Resta, Emanuela ; Attolini, Ettore ; Foschino Barbaro, Maria Pia. / Adherence to GOLD guidelines in real-life COPD management in the Puglia region of Italy. In: International Journal of COPD. 2018 ; Vol. 13. pp. 2455-2462.
@article{c5d1b9105beb4f68be87e5e79b835101,
title = "Adherence to GOLD guidelines in real-life COPD management in the Puglia region of Italy",
abstract = "Background: COPD is a disease associated with significant economic burden. It was reported that Global initiative for chronic Obstructive Lung Disease (GOLD) guideline-oriented pharmacotherapy improves airflow limitation and reduces health care costs. However, several studies showed a significant dissociation between international recommendations and clinicians' practices. The consequent reduced diagnostic and therapeutic inappropriateness has proved to be associated with an increase in costs and a waste of economic resources in the health sector. The aim of the study was to evaluate COPD management in the Puglia region. The study was performed in collaboration with the pulmonology centers and the Regional Health Agency (AReS Puglia).Methods: An IT platform allowed the pulmonologists to enter data via the Internet. All COPD patients who visited a pneumological outpatient clinic for the first time or for regular follow-ups or were admitted to a pneumological department for an exacerbation were considered eligible for the study. COPD's diagnosis was confirmed by a pulmonologist at the moment of the visit. The project lasted 18 months and involved 17 centers located in the Puglia region.Results: Six hundred ninety-three patients were enrolled, evenly distributed throughout the region. The mean age was 71±9 years, and 85{\%} of them were males. Approximately 23{\%} were current smokers, 63{\%} former smokers and 13.5{\%} never smokers. The mean post-bronchodilator forced expiratory volume in 1 second was 59{\%}±20{\%} predicted. The platform allowed the classification of patients according to the GOLD guidelines (Group A: 20.6{\%}, Group B: 32.3{\%}, Group C: 5.9{\%} and Group D: 39.2{\%}), assessed the presence and severity of exacerbations (20{\%} of the patients had an exacerbation defined as mild [13{\%}], moderate [37{\%}] and severe [49{\%}]) and evaluated the appropriateness of inhalation therapy at the time of the visit. Forty-nine percent of Group A patients were following inappropriate therapy; in Group B, 45.8{\%} were following a therapy in contrast with the guidelines. Among Group C patients, 41.46{\%} resulted in triple combination therapy, whil{\^e}14{\%} of Group D patients did not have a therapy or were following an inappropriate therapy. In conclusion, 30{\%} of all patients evaluated had been following an inadequate therapy. Subsequently, an online survey was developed to inquire about the reasons for the results obtained. In particular, we investigated the reasons why 30{\%} of our population did not follow the therapy suggested by the GOLD guidelines: 1) why was there an excessive use of inhaled corticosteroids, 2) why a significantly high percentage was inappropriately treated with triple therapy and 3) why a consistent percentage (11{\%}) of Group D patients were not treated at all.Conclusion: The data provides an overview on the management of COPD in the region of Puglia (Italy) and represents a resource in order to improve appropriateness and reduce the waste of health resources.",
author = "Palmiotti, {Giuseppe Antonio} and Donato Lacedonia and Vito Liotino and Pietro Schino and Francesco Satriano and {Di Napoli}, {Pier Luigi} and Eugenio Sabato and Vincenzo Mastrosimone and Alfredo Scoditti and Mauro Carone and Elio Costantino and Emanuela Resta and Ettore Attolini and {Foschino Barbaro}, {Maria Pia}",
year = "2018",
doi = "10.2147/COPD.S157779",
language = "English",
volume = "13",
pages = "2455--2462",
journal = "International Journal of COPD",
issn = "1176-9106",
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}

TY - JOUR

T1 - Adherence to GOLD guidelines in real-life COPD management in the Puglia region of Italy

AU - Palmiotti, Giuseppe Antonio

AU - Lacedonia, Donato

AU - Liotino, Vito

AU - Schino, Pietro

AU - Satriano, Francesco

AU - Di Napoli, Pier Luigi

AU - Sabato, Eugenio

AU - Mastrosimone, Vincenzo

AU - Scoditti, Alfredo

AU - Carone, Mauro

AU - Costantino, Elio

AU - Resta, Emanuela

AU - Attolini, Ettore

AU - Foschino Barbaro, Maria Pia

PY - 2018

Y1 - 2018

N2 - Background: COPD is a disease associated with significant economic burden. It was reported that Global initiative for chronic Obstructive Lung Disease (GOLD) guideline-oriented pharmacotherapy improves airflow limitation and reduces health care costs. However, several studies showed a significant dissociation between international recommendations and clinicians' practices. The consequent reduced diagnostic and therapeutic inappropriateness has proved to be associated with an increase in costs and a waste of economic resources in the health sector. The aim of the study was to evaluate COPD management in the Puglia region. The study was performed in collaboration with the pulmonology centers and the Regional Health Agency (AReS Puglia).Methods: An IT platform allowed the pulmonologists to enter data via the Internet. All COPD patients who visited a pneumological outpatient clinic for the first time or for regular follow-ups or were admitted to a pneumological department for an exacerbation were considered eligible for the study. COPD's diagnosis was confirmed by a pulmonologist at the moment of the visit. The project lasted 18 months and involved 17 centers located in the Puglia region.Results: Six hundred ninety-three patients were enrolled, evenly distributed throughout the region. The mean age was 71±9 years, and 85% of them were males. Approximately 23% were current smokers, 63% former smokers and 13.5% never smokers. The mean post-bronchodilator forced expiratory volume in 1 second was 59%±20% predicted. The platform allowed the classification of patients according to the GOLD guidelines (Group A: 20.6%, Group B: 32.3%, Group C: 5.9% and Group D: 39.2%), assessed the presence and severity of exacerbations (20% of the patients had an exacerbation defined as mild [13%], moderate [37%] and severe [49%]) and evaluated the appropriateness of inhalation therapy at the time of the visit. Forty-nine percent of Group A patients were following inappropriate therapy; in Group B, 45.8% were following a therapy in contrast with the guidelines. Among Group C patients, 41.46% resulted in triple combination therapy, whilê14% of Group D patients did not have a therapy or were following an inappropriate therapy. In conclusion, 30% of all patients evaluated had been following an inadequate therapy. Subsequently, an online survey was developed to inquire about the reasons for the results obtained. In particular, we investigated the reasons why 30% of our population did not follow the therapy suggested by the GOLD guidelines: 1) why was there an excessive use of inhaled corticosteroids, 2) why a significantly high percentage was inappropriately treated with triple therapy and 3) why a consistent percentage (11%) of Group D patients were not treated at all.Conclusion: The data provides an overview on the management of COPD in the region of Puglia (Italy) and represents a resource in order to improve appropriateness and reduce the waste of health resources.

AB - Background: COPD is a disease associated with significant economic burden. It was reported that Global initiative for chronic Obstructive Lung Disease (GOLD) guideline-oriented pharmacotherapy improves airflow limitation and reduces health care costs. However, several studies showed a significant dissociation between international recommendations and clinicians' practices. The consequent reduced diagnostic and therapeutic inappropriateness has proved to be associated with an increase in costs and a waste of economic resources in the health sector. The aim of the study was to evaluate COPD management in the Puglia region. The study was performed in collaboration with the pulmonology centers and the Regional Health Agency (AReS Puglia).Methods: An IT platform allowed the pulmonologists to enter data via the Internet. All COPD patients who visited a pneumological outpatient clinic for the first time or for regular follow-ups or were admitted to a pneumological department for an exacerbation were considered eligible for the study. COPD's diagnosis was confirmed by a pulmonologist at the moment of the visit. The project lasted 18 months and involved 17 centers located in the Puglia region.Results: Six hundred ninety-three patients were enrolled, evenly distributed throughout the region. The mean age was 71±9 years, and 85% of them were males. Approximately 23% were current smokers, 63% former smokers and 13.5% never smokers. The mean post-bronchodilator forced expiratory volume in 1 second was 59%±20% predicted. The platform allowed the classification of patients according to the GOLD guidelines (Group A: 20.6%, Group B: 32.3%, Group C: 5.9% and Group D: 39.2%), assessed the presence and severity of exacerbations (20% of the patients had an exacerbation defined as mild [13%], moderate [37%] and severe [49%]) and evaluated the appropriateness of inhalation therapy at the time of the visit. Forty-nine percent of Group A patients were following inappropriate therapy; in Group B, 45.8% were following a therapy in contrast with the guidelines. Among Group C patients, 41.46% resulted in triple combination therapy, whilê14% of Group D patients did not have a therapy or were following an inappropriate therapy. In conclusion, 30% of all patients evaluated had been following an inadequate therapy. Subsequently, an online survey was developed to inquire about the reasons for the results obtained. In particular, we investigated the reasons why 30% of our population did not follow the therapy suggested by the GOLD guidelines: 1) why was there an excessive use of inhaled corticosteroids, 2) why a significantly high percentage was inappropriately treated with triple therapy and 3) why a consistent percentage (11%) of Group D patients were not treated at all.Conclusion: The data provides an overview on the management of COPD in the region of Puglia (Italy) and represents a resource in order to improve appropriateness and reduce the waste of health resources.

U2 - 10.2147/COPD.S157779

DO - 10.2147/COPD.S157779

M3 - Article

C2 - 30147311

VL - 13

SP - 2455

EP - 2462

JO - International Journal of COPD

JF - International Journal of COPD

SN - 1176-9106

ER -