Diagnostic Value of PUMA E-Tool in Prospective Case Finding of COPD in Primary Care: A Real-World Implementation Analysis
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Abstract
Background COPD is a major cause of morbidity and mortality worldwide. Underdiagnosis is frequently reported since spirometry is not widely available in primary care settings. Therefore, a simple and accessible questionnaire-based strategy to select individuals for mandatory spirometry is desirable.
Methods: A cross-sectional study was performed to determine COPD prevalence among high-risk patients in five primary care facilities in Argentina and to assess the utility of PUMA score embedded in an electronic tool. Sample size was estimated between 683 to 893 cases for a prevalence of 20- 30% (with a CI of 95%), respectively.
Results: Over a 3-month period, a total of 866 patients were surveyed, with 836 meeting the inclusion criteria. The PUMA score was ≥ 5 in 503 patients and 440 patients underwent spirometry. Sixty-three patients were excluded (52 did not attend spirometry, 8 refused to participate and 3 for safety reasons). Spirometry diagnosed 120 cases of COPD, representing a COPD prevalence of 27.3% in the study population and 23.5% in the subgroup of patients with a PUMA score ≥ 5.
Conclusion: The PUMA score embedded in an electronic tool performed appropriately to select cases to diagnose COPD by spirometry in a primary care setting.
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