Clinical Audit on Chronic Obstructive Pulmonary Disease Management in Primary Care: The Greek COPD COCARE Cohort

Introduction: While clinical audits have long been evaluating the quality of COPD management within hospitals, evidence on primary care settings remains limited. The present study aimed to evaluate adherence to current guidelines in COPD through a clinical audit in primary care in Greece, identify gaps in clinical care and explore opportunities for improvement. Method: This is a clinical audit performed in eight primary care practices in Crete, Greece. Cases identified by GPs with an established diagnosis of COPD were included. The audit was conducted to compare the data contained in the patients’ records with the current recommendations, aiming to identify significant gaps and recommend appropriate actions for improvement. Clinical performance was categorized into five levels of appropriateness: excellent (>80%), good (60–80%), adequate (40–59%), inadequate (20–39%), and very inadequate (<20%). Results: During the audit process, 253 cases were included. Adherence to the different guideline statements presented an excellent or good adherence for smoking, vaccination (influenza and pneumococcal), exacerbations, recording of co-morbidities and further actions with chest X-ray or CT. However, guideline-concordant prescriptions for inhaled therapies were documented in only 34% of the patient population. The most outstanding areas for improvement included evaluating COPD risk factors beyond smoking, measuring alpha1-antitrypsin levels, monitoring treatment adherence, referring patients to pulmonary rehabilitation, considering eosinophil counts for treatment initiation, developing written self-management plans, and recording non-prescribed medications. Another finding of our study was the variability of adherence to guidelines noted between primary care settings, with a two-to-tenfold difference noted across various aspects of care between rural and urban areas. Discussion: Our results indicate that adherence to COPD guidelines among GPs is inconsistent and varies significantly between rural and urban settings. Such information must be accounted for by health care professionals and administrators in primary care, to improve strategies and establish better clinical practices. Funding: Chiesi Hellas