External validation of multidimensional prognostic indices (ADO, BODEx and DOSE) in a primary care international cohort (PROEPOC/COPD cohort).

BACKGROUND: Due to the heterogeneous and systemic nature of the chronic obstructive pulmonary disease (COPD), the new guidelines are oriented toward individualized attention. Multidimensional scales could facilitate its proper clinical and prognostic assessment, but not all of them were validated in an international primary care cohort, different from the original ones used for model development. Therefore, our main aim is to assess the prognostic capacity of the ADO, BODEx and DOSE indices in primary care for predicting mortality in COPD patients and to validate the models obtained in subgroups of patients, classified by revised Global Initiative for Chronic Obstructive Lung Disease (2011) and updated Spanish Guideline (2014). Besides, we want to confirm that the prognostic capacity of all indices increases if the number of exacerbations is substituted by the interval between them and to assess the impact on health of the patient's lifestyle, social network and adherence to treatment. METHODS: Design: External validation of scales, open and prospective cohort study in primary care. SETTING: 36 health centres in 6 European high, medium and low income countries. SUBJECTS: 477 patients diagnosed with COPD, captured in clinical visit by their General Practitioner/Nurse. PREDICTORS: Detailed patient history, exacerbations, lung function test and questionnaires at baseline. OUTCOMES: Exacerbations, all-cause mortality and specific mortality, within 5 years of recruitment. ANALYSIS: Multivariate logistic regression and Cox regression will be used. Possible non-linear effect of the indices will be studied by using Structured Additive Regression models with penalised splines. Subsequently, we will assess different aspects of the regression models: discrimination, calibration and diagnostic precision. Clinical variables modulated in primary care and the interval between exacerbations will be considered and incorporated into the analysis. DISCUSSION: The Research Agenda for General Practice/Family Medicine highlights that the evidence on predictive values of prognostic indices in primary care is scarce. A prospective cohort like that of PROEPOC/COPD provides good opportunities for research into COPD and make communication easier between family practitioners, nursing staff, pneumologists and other professionals, supporting a multi-disciplinary approach to the treatment of these patients. TRIAL REGISTRATION: ISRCTN52402811 . Date: 15/01/2015. Prospectively registered.

Utilización de la espirometría diagnóstica en los centros de salud de Tenerife / Use of Diagnostic Spirometry in Tenerife Health Centers

Objetivo: determinar el uso de la espirometría diagnóstica en el Área de Salud de Tenerife y la disponibilidad de medios materiales y humanos para su realización. Método: se efectuó un estudio descriptivo transversal en el periodo de marzo a junio de 2011, en el Área de Salud de Tenerife, que abarca toda la isla, en el que se incluyeron los 38 centros de salud del área. La recogida de datos se llevó a cabo mediante un cuestionario elaborado y administrado por el equipo investigador, basado en el publicado por Naveran et al (1994) y que consta de 18 preguntas sobre la utilización de la espirometria. Los entrevistados fueron los profesionales encargados de la realización de las pruebas y los responsables de la subdirección del centro, en caso de que no se realizase esta técnica. Resultados: se cumplimentaron los cuestionarios de los 38 centros (100%).El 89,4% de los centros de salud disponen de espirómetro; realizan espirometrías el 71%; en el 85% de los centros las espirometrías las efectúa enfermeras/os; el 96% de las cuales ha recibido una formación básica sobre la utilización de esta técnica; se calibra el espirómetro y se limpia y desinfecta cada vez que se utiliza en el 84,6% de los centros; la media de espirometrías a la semana por centro es de siete y el tiempo medio de espera es de 36 días Conclusiones: aunque es alto el porcentaje de centros de salud que realizan la espirometría, la mejora de la formación enfermera y de los ratios enfermera/médico podría incrementar la media de pruebas semanales y hacerla más accesible a la población (AU)

Objective: to determine the use of Diagnostic Spirometry in the Tenerife Healthcare Area, and the availability of material and human resources in order to perform it. Method: a transversal descriptive study was conducted from March to June, 2011, in the Tenerife Healthcare Area, including the whole island and the 38 health centers in the area. Data collection was conducted through a questionnaire prepared and administered by the research team, based on the one published by Naveran et al (1994), consisting of 18 questions about the use of spirometry. The respondents were the healthcare professionals responsible for conducting tests, and the Healthcare Center Section Managers, in those centers where the test was not conducted. Results: the questionnaires were completed in all 38 centers (100%).There is a spirometer in 89.4% of health centers; spirometries are conducted in 71% of health centers; spirometries are performed by nurses in 85% of health centers; 96% of said nurses have received basic training on the use of this technique; the spirometer is readjusted, cleaned and disinfected after each use in 84.6% of health centers; the average number of spirometries per week is seven, and the average time of wait is of 36 days. Conclusions: even though the proportion of health centers performing spirometry is high, an improvement in nurse training and nursephysician ratio could increase the average number of weekly tests, so that it became more accessible to the population (AU)