Records of all patients registered with a diagnosis of COPD were retrieved from EMRs with the use of the international classification of primary care code (ICPC) R95.11 Consultations for these patients during the 2-year study period were analysed by printing and subsequently reading and coding the EMRs. Two criteria were used to assess an exacerbation of COPD:
When patients visited their GP for an exacerbation more than once in a period of up to 3 weeks, the whole episode was considered one exacerbation. An exacerbation after full recovery from the previous exacerbation was considered a new episode, according to the GP's description in the EMR, or when the time between two consultations at the GP practice was longer than 3 weeks. Patients who were suspected to have a diagnosis of pneumonia, based on symptoms and physical examination, were excluded.
How this fits in
In the treatment of acute exacerbations of COPD, short courses of steroids are the primary treatment. However, antibiotic treatment is in most cases not indicated. Despite wide availability of treatment guidelines, this study found that GPs prescribed antibiotics more often than indicated.
The number of patients with exacerbations, number of exacerbations per patient, daily medication, and treatment prescribed for the exacerbation were registered. Exacerbations treated by pulmonologists after having been referred by a GP were counted separately.
