Primary care respiratory journal : journal of the General Practice Airways Group
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Exacerbations are now an important clinical variable for research into, and management of, chronic obstructive pulmonary disease (COPD). Emphasis is usually on reductions in the incidence of exacerbations and their impact on quality of life. For such research to be useful and comparable there needs to be a clearly defined understanding of what is meant by the term 'exacerbation'. The aim of this study was to explore the notion of COPD exacerbations from the viewpoint of patients who had recently suffered an exacerbation. ⋯ These data provide a new way of thinking about COPD exacerbations, offering a greater understanding and classification of the reasons underlying the decision of COPD patients to consult with HCPs. They suggest that the patient perspective of exacerbations is more complex than previously thought. These findings could be applied to clinical practice and research, facilitating focussed decisions on COPD management.
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Practice Guideline
International Primary Care Respiratory Group (IPCRG) Guidelines: management of chronic obstructive pulmonary disease (COPD).
COPD is a common and under-diagnosed disease which is increasing in prevalence worldwide. A more aggressive and optimistic approach must be adopted towards its management in primary care. ⋯ It highlights the goals of COPD treatment and the need for spirometric testing to make the diagnosis. It covers the classification of the disease according to disease severity, non-pharmacologic therapy including smoking cessation, avoidance of risk factors, patient education, pharmacologic therapy including the use of oxygen treatment, the management of exacerbations, the role of pulmonary rehabilitation, and the need for monitoring and ongoing care for COPD patients.
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This paper provides best practice recommendations for the appraisal of, and developmental support for, GPwSIs in respiratory medicine. These recommendations are closely linked with the current system for quality-assured National Health Service (NHS) general practice appraisal in the United Kingdom (UK). The recommendations are based on Department of Health guidance, and follow consultation with a range of relevant professional bodies involved in respiratory care and professional development. ⋯ In addition we address links to NHS general practitioner (GP) appraisal, revalidation, and documentation from the General Medical Council (GMC) on good medical practice. Developmental support that will complement and be sensitive to the needs of the GPwSI in respiratory medicine is described, as well as the ideal situation for educational support for practitioners, and the need for variability of appraisal dependent upon the GPwSI's experience. This appraisal and support system will allow general practice, NHS managers and the public to have confidence that those GPwSIs working in respiratory medicine will provide high quality care.
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To test whether participation in clinical audit is associated with improved care of a long-term health condition. ⋯ Patients with asthma benefit from being managed by a practice involved in a programme of audit.