Table 3.
Selected Clinical Decision-Making Patterns of Primary Care Physicians When Evaluating and Treating Patients With COPD
| Pattern | Primary Care Specialty | P Value | Guideline Use | P Value | ||
|---|---|---|---|---|---|---|
| Internal Medicine | Family and General Practice | User | Non-User | |||
| Assessment | ||||||
| Test to evaluate persistent dyspnea in a smoker w/normal CXR: % (number) | ||||||
| •Spirometry | 89.3% (285) | 90.5% (411) | .71 | 92.4% (181) | 89.2% (513) | .13 |
| •Peak flow measurement | 6.9% (22) | 5.1% (23) | 3.6% (7) | 6.6% (38) | ||
| •ECG | 0.9% (3) | 1.8% (8) | 2.6% (5) | 1.0% (6) | ||
| •ECHO | 0.9% (3) | 1.1% (5) | 1.0% (2) | 1.0% (6) | ||
| •No additional tests | 1.9% (6) | 1.5% (7) | 0.5% (1) | 2.1% (12) | ||
| Would order spirometry for subtle respiratory symptoms in a high-risk patient: % (number) | 72.5% (234) | 60.8% (278) | < .01* | 73.5% (144) | 62.8% (365) | < .01 |
| Interpret FEV and FEV1/FVC consistently with GOLD classification: % (number) | 64.4% (208) | 67.5% (309) | .37 | 66.8% (131) | 66.0% (384) | .83 |
| Treatment | ||||||
|---|---|---|---|---|---|---|
| Initial therapy for a smoker with mild COPD: % (number) | ||||||
| •No treatment | 23.8% (77) | 18.2% (83) | .20 | 14.4% (28) | 22.7% (132) | .02 |
| •Short-acting bronchodilator | 22.3% (72) | 25.4% (116) | 26.8% (52) | 23.2% (135) | ||
| •Long-acting bronchodilator | 23.8% (72) | 22.6% (103) | 28.9% (56) | 21.3% (124) | ||
| •Inhaled corticosteroid | 30.0% (97) | 33.8% (154) | 29.9% (58) | 32.8% (191) | ||
| Therapy for a 58-year-old smoker with persistent dyspnea unresponsive to antibiotics and short-acting bronchodilator, before spirometry: % (number) | ||||||
| •Different antibiotic | 0.0% (0) | 3.2% (7) | .07 | 2.4% (2) | 1.9% (5) | < .01 |
| •Long-acting anticholinergic | 40.3% (54) | 33.0% (73) | 49.4% (41) | 32.1% (87) | ||
| •Inhaled corticosteroid | 30.6% (41) | 27.6% (61) | 15.7% (13) | 32.1% (87) | ||
| •Combination short-acting beta-agonist/anticholinergic | 29.1% (39) | 36.2% (80) | 32.5% (27) | 34.0% (92) | ||
| Risk reduction for COPD patients | ||||||
|---|---|---|---|---|---|---|
| Would offer detailed smoking cessation counseling and arrange follow-up (%) | 76.0% (244) | 77.2% (349) | .70 | 83.2% (163) | 74.6% (429) | .01 |
*
Difference between specialty groups remained significant after controlling for guideline use (P < .01)