Antibiotic Prescription for COPD Exacerbations Admitted to Hospital: European COPD Audit

<div><p>Objective</p><p>Appropriate use of antibiotics in the management of hospitalised patients with COPD exacerbations is defined within the GOLD strategy. This paper analyses the factors associated with antibiotic prescribing in patients to better understand how prescribing may be improved.</p><p>Methods</p><p>The European COPD audit was a study of clinical care in 384 hospitals from 13 European countries between 2010 and 2011 enrolling 16018 patients. Those admitted to hospital due to a clinician-made diagnosis of exacerbation of COPD at the time of discharge were audited. We defined antibiotic prescribing compliance as consistent with the GOLD 2010 recommendations. Two different multivariate models were used to evaluate factors associated with the prescription of antibiotics and the guideline-compliant prescriptions.</p><p>Results</p><p>Overall 86% of admissions were given antibiotics but only 61.4% cases met the GOLD recommendations. Antibiotics were more likely to be given in hospital and at discharge if received prior to admission. Antibiotic prescription was more likely in patients who met the GOLD recommendations and in those with radiological consolidation but there was also a significant use of antibiotics in patients who did not meet either criterion. Patients cared for on a Respiratory Ward were more likely to receive GOLD compliant antibiotic management.</p><p>Conclusions</p><p>The present study describes the audited in-hospital antibiotic prescription for COPD exacerbation across different European countries. In general, there is an apparent overuse of antibiotics likely to be associated with both patient and practice-related variables.</p></div

Distribution of antibiotic prescription (A) and correct antibiotic prescription (B) between the participant countries.

<p>Red represent those countries with an average value significantly lower than the European average. Yellow represent those countries not significantly different from the European average. Green represent those countries with an average value significantly higher than the European average. White countries did not participate in the audit. Figure for illustrative purposes only.</p

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<p>Data expressed as mean (standard deviation) and absolute (relative) frequencies depending on the nature of the variable. ICR: inter-country range.</p><p>Characteristics of the patients included.</p

Characteristics of the patients included in the study between the study groups.

<p>Data expressed as mean (standard deviation) and absolute (relative) frequencies depending on the nature of the variable.</p><p>* p value calculated by Chi-squared test or Student T test for independent variables as appropriate.</p><p>Characteristics of the patients included in the study between the study groups.</p

Results from an Audit Feedback Strategy for Chronic Obstructive Pulmonary Disease In-Hospital Care: A Joint Analysis from the AUDIPOC and European COPD Audit Studies

<div><p>Background</p><p>Clinical audits have emerged as a potential tool to summarize the clinical performance of healthcare over a specified period of time. However, the effectiveness of audit and feedback has shown inconsistent results and the impact of audit and feedback on clinical performance has not been evaluated for COPD exacerbations. In the present study, we analyzed the results of two consecutive nationwide clinical audits performed in Spain to evaluate both the in-hospital clinical care provided and the feedback strategy.</p><p>Methods</p><p>The present study is an analysis of two clinical audits performed in Spain that evaluated the clinical care provided to COPD patients who were admitted to the hospital for a COPD exacerbation. The first audit was performed from November–December 2008. The feedback strategy consisted of personalized reports for each participant center, the presentation and discussion of the results at regional, national and international meetings and the creation of health-care quality standards for COPD. The second audit was part of a European study during January and February 2011. The impact of the feedback strategy was evaluated in term of clinical care provided and in-hospital survival.</p><p>Results</p><p>A total of 94 centers participated in the two audits, recruiting 8,143 admissions (audit 1<b>∶</b>3,493 and audit 2<b>∶</b>4,650). The initially provided clinical care was reasonably acceptable even though there was considerable variability. Several diagnostic and therapeutic procedures improved in the second audit. Although the differences were significant, the degree of improvement was small to moderate. We found no impact on in-hospital mortality.</p><p>Conclusions</p><p>The present study describes COPD hospital care in Spanish hospitals and evaluates the impact of peer-benchmarked, individually written and group-oral feedback strategy on the clinical outcomes for treating COPD exacerbations. It describes small to moderate improvements in the clinical care provided to COPD patients with no impact on in-hospital mortality.</p></div

Diagnostic procedures performed during admission in each audit.

<p>Data are expressed as the mean (standard deviation) or absolute (relative) frequencies. NS: not significant. PaO₂: partial pressure of oxygen in arterial blood. PaCO₂: partial pressure of carbon dioxide in arterial blood.</p><p>*Calculated using the unpaired Student’s <i>t</i>-test or chi-square test.</p><p>Diagnostic procedures performed during admission in each audit.</p

Characteristics of the patients included in each audit.

<p>Data are expressed as the mean (standard deviation) or absolute (relative) frequencies. NS: not significant. FEV₁: forced expiratory volume in one second.</p><p>*Calculated using the unpaired Student’s <i>t</i>-test or chi-square test.</p><p>Characteristics of the patients included in each audit.</p

Kaplan-Meier curves comparing the in-hospital survival between the audits.

<p>The grey line represents the first audit. The black line represents the second audit.</p