COPD Management in Primary Care: Underutilisation of Nursing Consultations.

Abstract

Objective: To describe the clinical profile, comorbidity burden, follow-up and healthcare utilisation in patients labelled as having Chronic Obstructive Pulmonary Disease (COPD) in Primary Care (PC) nursing consultations.

Design: Real-world data COPD, retrospective, observational study using routinely collected data in electronic health records (EHR). This study adheres to the STROBE reporting guidelines for cross-sectional studies.

Location: Three Primary Care centres in Catalonia, Spain, belong to the Catalan Health Service.

Participants: All patients aged ≥ 15 years with a recorded diagnosis of COPD in their EHR, excluding institutionalised individuals and those deceased before study onset. Final sample: 474 patients (105 women, 369 men; mean age 70 years) from a reference population of 28,000 individuals.

Main measurements: Data included socio-demographics, smoking/alcohol, mMRC dyspnea, inhaled therapy/adherence, spirometry, comorbidities, Adjusted Morbidity Groups (GMA), active COPD care plans and 12-month healthcare use.

Results: EHR showed a high rate of missing data in follow-up variables (inhaler adherence 28.5%; dyspnea 17%-20%). Despite that, all participants were 'labelled' as COPD, most of them lacked spirometric confirmation. Active smoking was highly prevalent (52.3% women, 45.0% men). Hypertension, obesity and osteoarthritis were the most common comorbidities; anxiety, depression, osteoporosis and thyroid disorders were more frequent in women. Higher GMA complexity correlated with more Primary Care visits, especially nursing consultations, particularly in patients with cardiovascular disease and diabetes (p < 0.001) for 12 months follow-up. No significant differences between groups were found in urgent or hospital care use.

Conclusions: EHR-labelled COPD patients with cardiometabolic comorbidity received more structured nursing follow-up and more annual visits than without. Improving EHR recording, integrating spirometry with the EHR, and prioritising high-complexity profiles could enhance monitoring, treatment optimisation and equity-nursing consultations are a key lever.

Patient or public contribution: No patients or members of the public were directly engaged in the study design or data analysis. Nevertheless, the research was motivated by patient needs and aims to improve healthcare services.