Insights into the Follow-Up of Patients with COPD in Daily Practice: Results from a Spanish Delphi Consensus ("The SEGUIPOC Study”)

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Abstract
Purpose: To develop a consensus document on how to follow-up patients with COPD in clinical practice in Spain. Methods: A qualitative, three-round Delphi survey was conducted in the framework of Spanish pneumologists attending COPD patients in routine daily practice. Participants completed a 35-item questionnaire on how to follow-up COPD patients, according to four sections: 1) assessment of the patient’s clinical conditions, 2) therapeutical interventions, 3) frequency of follow-up visits, and 4) healthcare pathways. Consensus was defined if more than 70% of participants agree. Results: A total of 155 specialists in respiratory medicine (53% men; mean age 47 years) participated in the study (69% with more than 10 years of professional practice). More than 80% of participants agreed on the use of clinical practice guidelines but 81.9% considered that recommendations on follow-up should be more explicit. Assessment of lung function (FEV1), dyspnea, and exacerbations were the clinical variables that reached a higher level of consensus. Dyspnea values were reported as the main indicator to assess increased bronchodilation, and exacerbations were the most important to assess the use of inhaled corticosteroids. Follow-up of low-risk patients should be performed in the primary care setting, and patients should be visited every 12 months, whereas high‑risk patients should be monitored by pneumologists and including nursing visits. Conclusion: The participants agree that the guidelines should include more specific indications to define the follow-up of the COPD patient, and there is lack of evidence in many aspects. There is consensus on the importance of care to coordinate with nursing and primary care, but the protocols to follow and the working tasks for each healthcare setting remain unclear.