Appropriateness of chronic obstructive pulmonary disease (COPD) management per global initiative for chronic obstructive lung disease (GOLD) guidelines at a family medicine practice

PURPOSE: This retrospective study evaluated the appropriateness of COPD management per GOLD guidelines at a family medicine practice associated with a major academic medical center. Areas identified for improvement may be targeted by a pharmacist-managed clinic within the family medicine practice.

METHODS: Individuals who were patients of the family medicine center and had been assigned an ICD-9 diagnosis of COPD were identified by querying the practice’s electronic medical records. In order to be included, patients must have been ≥ 42 years of age as of 12/31/09, seen 3 times in the past 3 years and once during measurement period (5/1/10–4/30/11) by a provider of the family medicine center, and had documented COPD staging. Age, race, pulmonary function tests (if available), and current medications for COPD were recorded.

RESULTS: Of the 78 patients reviewed, 71 were included for analysis. Per GOLD guidelines, 50.7% (36/71) received appropriate medication management (i.e., bronchodilators and corticosteroids) based on documented COPD stage. Of those who did receive appropriate management, 11.1% (4/36) received inadequate dosing of COPD medications.

CONCLUSION: Appropriately staging COPD, as well as reassessing currently prescribed medications, inhaler technique, and adherence at follow-up visits, are vital to patient care. Pharmacists are uniquely positioned to maximize COPD outcomes. A pharmacist-managed clinic may be of benefit to the multidisciplinary care of COPD patients and aid in exceeding national measurements. In addition, documentation of COPD management at this particular practice may be improved.