Management of Chronic Obstructive Pulmonary Disease in Primary Health Care – Evaluation of family physician’s perceptions about usual care

Introduction: Some of the most important problems related to Chronic Obstructive Pulmonary Disease are the underdiagnosis and misdiagnosis, combined with insufficient follow-up by family physicians. One previous work of the authors showed this is very significant in Braga Health Centre Group. The objectives were to describe family physicians' perceptions about their current practices concerning the diagnosis and management of these patients, as well as to understand which factors may contribute to the
mentioned problems. 

Methods: This was an observational, cross-sectional, descriptive study, with quantitative and qualitative approaches. It was approved by local and regional ethics
committee. All family physicians working in Braga Health Centre Group were invited to participate. An online survey, composed of multiple choice and opened-ended
questions, was distributed by email. 

Results: So far, 57 doctors have answered the questionnaire, from which 63% say they are proactive in the search for new diagnoses. Almost 50% state that difficulties in spirometry access and reduced demand for symptomatic patients are the most important barriers for the diagnosing process. Near 70% claim to perform, at least, an yearly evaluation of each COPD patient, in which almost 80% say they evaluate symptoms and exacerbations. Most of the participants declare to prescribe only long-acting bronchodilators. Around 40% says that the inexistence of an organized respiratory consultation is the most significant impediment for a more regular follow-up of these patients.

Discussion: This work was prepared as a consequence of a previous one, in the same region, where many insufficiencies were detected in the diagnosis and follow-up of COPD patients. These results are very interesting as there are important discrepancies between what was previously seen to be registered and what physicians claim to do. As seen in the existing literature, spirometry and work related limitations are pointed out as relevant threats.