Assessment Of Adherence To Health Quality Ontario Standards For COPD Care In A Rural Primary Care Setting: A Retrospective Chart Review

PURPOSE: Up to 80% of care for Chronic Obstructive Pulmonary Disease (COPD) is delivered by primary care physicians. However, in rural areas access to primary care is lower, with worse COPD outcomes. To ensure a high level of care for COPD in a rural Ontario setting we evaluated adherence to Health Quality Ontario’s (HQO) Quality Standards for COPD in a primary care setting. The purpose of this study was to determine if HQO’s Quality Standards (QS) were being met in this setting. The secondary aim of the study was to determine if any characteristics are predictive of the HQO QS met. METHODS: A retrospective chart review was conducted using a random sample of patients (n = 80) aged 18 years and older with diagnosed COPD. The sample was drawn from one rural Ontario health clinic. All information was extracted from primary care electronic medical records. The main outcome measure was adherence to HQO’s Quality Standards for COPD. This was accessed using a local data collection approach for 13 of 14 of the HQO standards. The secondary aim was addressed by using regression modeling to determine if clinical or demographic characteristics were predicative of HQO QS met. RESULTS: Eighty participants were included in the study (39% female, mean age 72.3 (±9.74) years, mean COPD history of 6.2 (±3.5) years. The most frequently met HQO Quality Standards were 1) Diagnosis Confirmed with Spirometry (72%; 44/61), 2) Appropriate Pharmacological Management of Stable COPD (73%; 219/300), and 3) Vaccinations (63%; 101/160). Standards that were never met included: 4) Pulmonary Rehabilitation (PR) (0/150), 5) Management of Acute Exacerbations of COPD (0/35), and lastly 6) PR After Hospitalization for an Acute Exacerbation of COPD (0/26). All other QS were met between 24% and 50%. Utilizing linear regression, four characteristics were significantly associated with the level of care received by the individual, including: a) participation in a self-management program, b) a visit to primary care for COPD in the past 12 months, c) non-smoking status, and d) seen by a Respirologist ever (R2 = 0.754, F (12,64) = 23.3, p < 0.001). CONCLUSION: Adherence to HQO care standards is lacking, on average each individual received 37% of HQO QS. Characteristics associated with better COPD care overall may help identify opportunities for improvement. Sponsored by MF Mottola FACSM