A Survey of Physicians' Perception of the Use and Effectiveness of Diagnostic and Therapeutic Procedures in Chronic Cough Patients.

PURPOSE: The aim of this study was to understand the perception of family physicians, pulmonologists, and allergists with respect to diagnostic tests performed on patients with chronic cough and treatments prescribed to patients with refractory or unexplained chronic cough. We also assessed how these health professionals perceived the effectiveness of these treatments. METHODS: An anonymous survey was distributed by the scientific societies SEPAR, SEAIC, SEMERGEN, semFYC, and SEMG. Respondents were asked how often they perform diagnostic tests and prescribe treatments (responses from 1 = never to 10 = always) and how they perceived the effectiveness of the drugs used (from 1 = not at all to 10 = very effective). The correlation between perceived effectiveness and frequency of prescription was analyzed. RESULTS: The respondents comprised 620 family physicians, 92 pulmonologists, and 62 allergists. The most frequently performed diagnostic tests were chest x-ray and, among pulmonologists and allergists, simple spirometry and bronchodilator tests. The most frequently prescribed drugs were bronchodilators (percentages scoring 8-10 for each specialty: 43.2%, 42.4%, and 56.5%; p = 0.127), inhaled corticosteroids (36.9%, 55.4%, and 54.8%; p < 0.001), and antitussives (family physicians, 33.4%). Regarding perceived effectiveness, only bronchodilators, inhaled or oral corticosteroids, and opioids obtained a median effectiveness score > 5 (between 6 and 7). Correlation coefficients (ρ2) suggested that approximately 45% of prescription was related to perceived effectiveness. CONCLUSION: Although chronic cough is a common problem, diagnosis and treatment differ among specialists. The perceived effectiveness of drugs is generally low.

Control del asma en pacientes que acuden a consulta de atención primaria en España (estudio ACTIS) / Asthma control in patients attending primary care in Spain (Actis study)

OBJETIVO: Evaluar la prevalencia de asma no controlada (puntuación < 20 en el Asthma Control Test [ACT]) en la práctica clínica habitual en España. DISEÑO: Estudio observacional, transversal. Emplazamiento: Cincuenta y ocho centros de atención primaria de 13 comunidades autónomas. PARTICIPANTES: Pacientes asmáticos atendidos por consulta administrativa sin empeoramiento subjetivo (grupo A) o por empeoramiento de sus síntomas (grupo B). Mediciones principales: Características sociodemográficas (edad, sexo, educación y tabaquismo), nivel de gravedad del asma según el médico, terapia actual para el asma, enfermedades concomitantes, utilización de recursos sanitarios (consultas, hospitalizaciones y urgencias), absentismo laboral y escolar, puntuación ACT y adherencia al tratamiento. RESULTADOS: Se incluyeron 376 pacientes del grupo A y 262 del grupo B. El 59% eran mujeres, edad media de 45 años, 21% fumadores y tiempo medio de evolución del asma 8,9 años. El 87% usaban agonistas beta-2 de corta duración, el 62% beta-2 de larga duración asociados con corticoides inhalados y el 13,8% corticoides inhalados regularmente. Se observó mal control del asma en el 75,6% del grupo B y en el 23,4% del grupo A; solo el 5,3% del grupo A presentaba control total (ACT = 25). Un peor control del asma se asociaba significativamente con mayor duración de la enfermedad y mayor uso de recursos. CONCLUSIONES: La prevalencia de asma no controlada en pacientes que acuden a la consulta de atención primaria por empeoramiento de sus síntomas continúa siendo muy elevada. El mal control del asma se asocia con un elevado uso de recursos e impacta significativamente en la carga de la enfermedad

OBJECTIVE: To assess prevalence of non controlled (ACT- Asthma Control Test < 20) asthma in real world clinical practice in Spain. DESIGN: Observational, cross-sectional study. LOCATION: 58 primary care centers from 13 Autonomous Communities. PARTICIPANTS: Asthma patients attending physicians office to collect repeat prescriptions for continuous treatment (Group A), or due to symptoms worsening (Group B). MAIN MEASUREMENTS: Socio-demographic characteristics (age, gender, education, smoking history), physician's assessment of asthma severity, current treatment for asthma, co-morbidities, healthcare-related resources utilization (primary care or emergency visits, hospitalizations), labour or school absenteeism, ACT score and treatment adherence. RESULTS: 376 patients from group A and 262 from group B were included, 59% female, mean age 45 years, 21% smokers and time since asthma diagnosis 8.9 years. 87% were on short acting beta-2 agonists, 62% long acting beta-2 agonists with inhaled corticosteroids and 13.8% regular inhaled corticosteroids. Poor asthma control was observed in 75.6% from group B and 23.8% from group A; only 5.3% from group A showed total asthma control (ACT = 25). Poorer asthma control was significantly associated with longer disease duration and higher use of resources. CONCLUSIONS: Prevalence of poor asthma control among patients attending due to symptoms worsening continues to be very high even in patients who come to renew their prescription. Poor asthma control is associated to high use of resources and high impact on burden of disease

[Asthma control in patients attending primary care in Spain (Actis study)]. / Control del asma en pacientes que acuden a consulta de atención primaria en España (estudio ACTIS).

OBJECTIVE: To assess prevalence of non controlled (ACT- Asthma Control Test<20) asthma in real world clinical practice in Spain. DESIGN: Observational, cross-sectional study. LOCATION: 58 primary care centers from 13 Autonomous Communities. PARTICIPANTS: Asthma patients attending physicians office to collect repeat prescriptions for continuous treatment (Group A), or due to symptoms worsening (Group B). MAIN MEASUREMENTS: Socio-demographic characteristics (age, gender, education, smoking history), physician's assessment of asthma severity, current treatment for asthma, co-morbidities, healthcare-related resources utilization (primary care or emergency visits, hospitalizations), labour or school absenteeism, ACT score and treatment adherence. RESULTS: 376 patients from group A and 262 from group B were included, 59% female, mean age 45 years, 21% smokers and time since asthma diagnosis 8.9 years. 87% were on short acting beta-2 agonists, 62% long acting beta-2 agonists with inhaled corticosteroids and 13.8% regular inhaled corticosteroids. Poor asthma control was observed in 75.6% from group B and 23.8% from group A; only 5.3% from group A showed total asthma control (ACT=25). Poorer asthma control was significantly associated with longer disease duration and higher use of resources. CONCLUSIONS: Prevalence of poor asthma control among patients attending due to symptoms worsening continues to be very high even in patients who come to renew their prescription. Poor asthma control is associated to high use of resources and high impact on burden of disease.