The analysis of an integrated care pathway in general pratice: the case of COPD

Airflow obstruction and Chronic Obstructive Pulmonary Disease (COPD) are probably underestimated in General Practice. In order to improve quality of care, efficiency, and the integration between primary care and hospital services, the Local Health Authority launched a Disease Management Project related to Integrated Care Pathways (ICPs) for some chronic diseases. A group of ten GPs decided to realize an audit experience about their management of COPD. The aims of the study were: 1) to analyse the quality of GPs medical records related to COPD patients; 2) to estimate the prevalence and incidence of COPD; 3) to evaluate the applicability of guidelines related to COPD diagnosis, management and prevention (GOLD guidelines 2005) in general practice. Methods. The study was an observational audit. Ten GPs during one year collected data related to their patients with COPD diagnosis or airflow obstruction and to new suspected cases. The data collected concerned spirometry for diagnosis and stage classification, cigarette smoking, influenza vaccination, pharmacological treatment, exacerbations, referral to specialists and hospital admissions. Results. Patients selected with suspected or confirmed COPD were 196 with a prevalence rate, within population assisted, of about 1.3 %. The audit showed that it’s not always possible to apply the guidelines, especially spirometry for diagnosis and stadiation. Many patients are in stage 0-1 and it should be necessary to improve GPs interventions in counselling for smoking cessation. An educational programme about management of pharmacological treatments could be useful and integration and communication between primary and secondary care is difficult to realize.