Comparison of a network of primary care physicians and an open spirometry programme for COPD diagnosis
ABSTRACT Early diagnosis of Chronic Obstructive Pulmonary Disease (COPD) remains the cornerstone for effective management. In this study we compared an open spirometry programme and a case-finding programme providing spirometry to high-risk subjects selected by primary care physicians.
A network of primary care physicians was created after invitation and all participants received training on COPD and spirometry. The study team visited 12 primary care settings in each programme in a 1-year period. Spirometry was performed in all eligible participants. COPD diagnosis and classification was based on GOLD guidelines and evaluation by a chest physician.
Patients with acceptable spirometry were evaluated (n = 201 in the case-finding and n = 905 in the open spirometry programme). The proportion of newly diagnosed COPD was 27.9% in the case-finding programme compared to 8.4% in the open spirometry programme (p < 0.0001). The number needed-to-screen (NNS) for a new diagnosis of COPD was 3.6 in the case-finding programme compared to 11.9 in the open spirometry programme. The majority of newly diagnosed patients were classified in GOLD stages I an II. The average cost for a new diagnosis of COPD was 173 € in the open spirometry programme and 102 € in the case-finding programme.
A case-finding programme involving primary care physicians was more cost-effective for the identification of new cases of COPD compared to an open spirometry programme. The development of networks of primary care physicians with access to good quality spirometry and specialist consultation for early diagnosis of COPD is justified.
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ABSTRACT: Quality and features of tele-homecare are improved by information and communication technologies. In this context, a pulse oximeter-based mobile biotelemetry application is developed. With this application, patients can measure own oxygen saturation and heart rate through Bluetooth pulse oximeter at home. Bluetooth virtual serial port protocol is used to send the test results from pulse oximeter to the smart phone. These data are converted into XML type and transmitted to remote web server database via smart phone. In transmission of data, GPRS, WLAN or 3G can be used. The rule based algorithm is used in the decision making process. By default, the threshold value of oxygen saturation is 80; the heart rate threshold values are 40 and 150 respectively. If the patient's heart rate is out of the threshold values or the oxygen saturation is below the threshold value, an emergency SMS is sent to the doctor. By this way, the directing of an ambulance to the patient can be performed by doctor. The doctor for different patients can change these threshold values. The conversion of the result of the evaluated data to SMS XML template is done on the web server. Another important component of the application is web-based monitoring of pulse oximeter data. The web page provides access to of all patient data, so the doctors can follow their patients and send e-mail related to the evaluation of the disease. In addition, patients can follow own data on this page. Eight patients have become part of the procedure. It is believed that developed application will facilitate pulse oximeter-based measurement from anywhere and at anytime.Studies in health technology and informatics 01/2012; 181:197-201.
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ABSTRACT: Chronic obstructive pulmonary disease (COPD) represents a significant burden for healthcare systems that is expected to grow further in the future. Inhaled long-acting bronchodilators, including tiotropium, represent the cornerstone of management of COPD patients. Economic studies evaluating the cost-effectiveness ratio of inhaled bronchodilators have to take into account several parameters, including the reduction of COPD exacerbations and related hospitalizations, as well as disease modification and improvement in quality of life and mortality. At an era when the healthcare resources are unlikely to grow as quickly as demand, economic analyses remain the cornerstone for the justification of the broad use of medication with an acceptable cost-effectiveness ratio. The greatest importance of such studies in COPD is the identification of subgroups of patients that will have the most benefit with an acceptable cost-effectiveness ratio for the healthcare providers. The development of models that will incorporate a global evaluation of the different aspects of this multi-component disease, in order to provide the best available care to each individual patient is urgently needed.BMC Pulmonary Medicine 09/2010; 10:48. DOI:10.1186/1471-2466-10-48 · 2.49 Impact Factor
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ABSTRACT: This article reviews a selection of presentations at the 2010 annual meeting of the European Respiratory Society held in Barcelona, Spain, which was the largest congress ever in the field of respiratory medicine. The best abstracts from the groups of the Clinical Assembly (Clinical Problems, Rehabilitation and Chronic Care, Imaging, Interventional Pulmonology, Diffuse Parenchymal Lung Disease, and General Practice and Primary Care) are presented in the context of the current literature.European Respiratory Journal 03/2011; 38(1):209-17. DOI:10.1183/09031936.00039011 · 7.13 Impact Factor