Keywords: COPD; proactive medicine; general medicine; teamwork; appropriate prescribing.

Background:

Chronic obstructive pulmonary disease (COPD) is a significant cause of morbidity in the general population, often underdiagnosed and suboptimally managed in general practice. Proactive medicine allows for early identification of clinical issues, improving diagnostic and therapeutic appropriateness and outcomes.

Research questions:

The study (retrospective audit followed by an observational study) aims to evaluate a proactive medicine model for the active management of COPD in general practice, through the administration of validated questionnaires (CAT and mMRC) by the study team, which led to a subsequent reassessment of patients with clinical criticalities.

Method:

In the first phase, of the 1,500 patients assisted by a GP, 41 (2,7%, like HealthSearch) were identified with a diagnosis of COPD, using the software Milleutility/MilleGPG; 39 were included.
The following data were collected:
- Personal data;
- Smoking habit (data updated within the last three years at the latest);
- Flu vaccination status in the past year;
- Number and severity of exacerbations in the previous two years.
In the second phase, teamGP collaborators administered the CAT and mMRC questionnaires to the patients included in the study. Patients were then stratified by the physician into COPD groups, taking into account symptoms and exacerbations, current treatment, and smoking habits.

Results:

Following the stratification performed, it emerged that:
- 17 patients (43,6%) need to repeat spirometry;
- 29 patients (74,4%) need to receive a clinical re-evaluation, and in particular:
- 13 patients require a therapeutic change, due to the absence or insufficient drug according to current guidelines
- 5 patients require priority anti-smoking counseling
- 7 patients need both procedures
- 4 patients need to be re-evaluated for the reported symptoms

Conclusions:

The proposed proactive medicine model has proven to be feasible and clinically relevant in general medicine practice enabling the identification and stratification of patients with critical conditions, and consequently their management.

Points for discussion:

It would be interesting to observe if a reduction of exacerbations will be registered a year after therapy correction

How to standardize a definitive version of this method to uniform provided care?