Adherence to COPD management guidelines in general practice? A review of the literature

Sehl, J; O’Doherty, Jane; O'Connor, Raymond G.; O’Sullivan, Brian; O’Regan, Andrew

doi:10.1007/s11845-017-1651-7

Cited by 45 publications

(50 citation statements)

References 24 publications

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“…(Table 1S). A recent review including 11 studies performed in multiple countries across the globe showed a significant variability in the adherence rates to the GOLD PTGs [40]. For example, the pulmonologists' adherence rates to some other GOLD PTGs varied from 70.1% (Greece) [41] to 18.7% (USA) [7] ( Table 1S).…”

Section: Discussion Of Results the Evaluation Of Pulmonologists'mentioning

confidence: 99%

Adherence of North‐African Pulmonologists to the 2017‐Global Initiative for Chronic Obstructive Lung Disease (GOLD) Pharmacological Treatment Guidelines (PTGs) of Stable Chronic Obstructive Pulmonary Disease (COPD)

Aissa

Knaz

Maatoug

et al. 2020

BioMed Research International

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Background. No previous study has investigated the adherence rate of North-African pulmonologists to the 2017-GOLD PTGs. Aims. To investigate the adherence rate of Tunisian pulmonologists to the 2017-GOLD PTGs and to identify the barriers to their adherence. Methods. This was a cohort study involving clinically stable COPD patients who presented to a pulmonology outpatient consultation. The patients were classified as having been appropriately and inappropriately (over- or undertreatment) treated for the GOLD group. Logistic regression was performed to determine the adherence barriers to the 2017-GOLD PTGs. Results. A total of 296 patients were included (88.1% males, mean age: 68±10 years; GOLD A (7.1%), B (36.1%), C (4.1%), and D (52.7%)). The pulmonologists’ adherence rate to the 2017-GOLD PTGs was 29.7%. There was a significant statistical difference between the adherence rates among the four GOLD groups (A: 19.0%, B: 20.6%, C: 8.3%, and D: 39.1%; p=0.001). Differences were statistically significant between the GOLD group D and groups B (p=0.001) and C (p=0.033). The multivariate analysis showed that age (odds ratio (OR): 0.968), socioeconomic level (high/medium vs. low; OR: 2.950), insurance type (national health insurance vs. others; OR: 2.851), and GOLD groups (A/B vs. C/D; OR: 3.009) significantly influenced the adherence rate to the 2017-GOLD PTGs. Conclusion. The adherence rate of Tunisian pulmonologists to the 2017-GOLD PTGs is low. It seems that the patients’ age, socioeconomic level, national health insurance coverage, and GOLD groups influenced their adherence.

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Section: Discussion Of Results the Evaluation Of Pulmonologists'mentioning

confidence: 99%

Adherence of North‐African Pulmonologists to the 2017‐Global Initiative for Chronic Obstructive Lung Disease (GOLD) Pharmacological Treatment Guidelines (PTGs) of Stable Chronic Obstructive Pulmonary Disease (COPD)

Aissa

Knaz

Maatoug

et al. 2020

BioMed Research International

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“…Unfortunately, poor guideline adherence was frequently found in real-world practice in COPD. 23 The rate of guideline adherence for pulmonologists in Turkey was 59.5% according to the earlier 2006 GOLD report. 24 The guideline adherence rate was even lower for general practitioners (GPs) than for pulmonologists in Italy, 25 and the rate was as low as 8% for GPs in a Shanghai suburb.…”

Section: Discussionmentioning

confidence: 99%

The impact of 2011 and 2017 Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) guidelines on allocation and pharmacological management of patients with COPD in Taiwan: Taiwan Obstructive Lung Disease (TOLD) study

Hsieh¹,

Huang²,

Yang³

et al. 2018

COPD

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BackgroundThis nationwide study was performed to evaluate the evolution of distributions of patients with COPD according to the 2011 and 2017 Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) guidelines and to assess the concordance between the prescribed medications and the pharmacological management recommended by the two distinct classification systems in Taiwan.Subjects and methodsData were retrospectively retrieved from stable COPD patients in 11 participating hospitals across Taiwan. Patients were grouped according to GOLD 2011 and 2017 guidelines respectively. Definitions of undertreatment and overtreatment were based on the pharmacological recommendations in the individual guidelines.ResultsA total of 1,053 COPD patients were included. The percentages of patients in GOLD 2011 groups A, B, C and D were 18.4%, 40.6%, 6.7% and 34.2%, respectively. When reclassified according to the GOLD 2017, the percentages of group A and B increased to 23.3% and 63.2%, and groups C and D decreased to 1.9% and 11.6%, respectively. Up to 67% of patients in GOLD 2011 groups C and D were reclassified to GOLD 2017 groups A and B. The pharmacological concordance rate was 60.9% for GOLD 2011 and decreased to 44.9% for GOLD 2017. Overtreatment was found in 29.5% of patients according to GOLD 2011 and the rate increased to 46.1% when classified by the GOLD 2017. The major cause of overtreatment was unnecessary inhaled corticosteroids and the main cause of undertreatment was a lack of maintenance long-acting bronchodilators.ConclusionThe distribution of COPD patients in Taiwan was more uneven with the GOLD 2017 than with the GOLD 2011. A pharmacological discordance to the guidelines was identified. Updated guidelines with reclassification of COPD patients resulted in more discordance between prescribed medications and the guidelines. Physicians should make proper adjustments of the prescriptions according to the updated guidelines to ensure the mostly appropriate treatment for COPD patients.

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“…1 A recent review found considerable variability among physicians' adherence to guideline recommendations, showing that the proportion of patients adequately prescribed ranged from 30% to 60%. 12 Data from a US cohort showed that appropriateness ranged from 30% to 45%. 4 A previous Italian study, held in the context of specialized lung clinics, found that only 37.9% of COPD patients were treated according to GOLD recommendations even though they were managed by specialized physicians.…”

Section: Discussionmentioning

confidence: 99%

“…At admission, 23.1% of them were treated with at least 1 LABA and 24.2% were treated with at least 1 LAMA. Regarding the association of [2][3][4][5][6][7][8][9][10][11][12][13][14] .001 Education, y (n ¼ 5523) 5 [5][6][7][8][9] 5 [5][6][7][8] . Table S2).…”

Section: Pharmacologic Treatment and Therapeutic Appropriatenessmentioning

confidence: 99%

“…Educational interventions are warranted to increase adherence to guidelines with the goal of improving patients' quality of life and reducing the impact of major clinical events. [1][2] .131 SBT (n ¼ 926*) 9 [4][5][6][7][8][9][10][11][12][13][14][15][16] 8 [2][3][4][5][6][7][8][9][10][11][12][13][14] .154 Education, y (n ¼ 1190) 5 [5][6][7][8] 5 [5][6][7][8] . [22.8-29.3] 26.1 [22.8-28.9] .333 GDS (n ¼ 878*) 1 [0-2] 1 [1][2] .115 SBT (n ¼ 926*) 8 [2][3][4][5][6][7][8][9][10][11]…”

Section: Conclusion and Relevancementioning

confidence: 99%

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Hospital Care of Older Patients With COPD: Adherence to International Guidelines for Use of Inhaled Bronchodilators and Corticosteroids

Proietti¹,

Agosti²,

Lonati³

et al. 2019

Journal of the American Medical Directors Association

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Keywords:COPD older patients guidelines adherence major clinical events a b s t r a c tObjectives: We aimed to analyze the prevalence and impact of COPD in older patients hospitalized in internal medicine or geriatric wards, and to investigate adherence to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, associated clinical factors, and outcomes. Design: Data were obtained from REgistro POliterapie SIMI (REPOSI), a prospective multicenter observational registry that enrolls inpatients aged 65 years. Setting and Participants: Older hospitalized patients enrolled from 2008 to 2016 with a diagnosis of COPD. Measures: We evaluated adherence to the 2018 GOLD guidelines at admission and discharge, by examining the prescription of inhaled bronchodilators and corticosteroids in COPD patients. We also evaluated the occurrence of outcomes and its association with COPD and guideline adherence. Results: At hospital admission, COPD was diagnosed in 1302 (21.5%) of 6046 registered patients. COPD patients were older, with more impaired clinical and functional status and multiple comorbidities. Overall, 34.3% of COPD patients at admission and 35.6% at discharge were adherent to the GOLD guidelines. Polypharmacy (5 drugs) at admission [odds ratio (OR): 3.28, 95% confidence interval (CI): 2.24-4.81], a history of acute COPD exacerbation (OR: 2.65, 95% CI: 1.44-4.88) at admission, smoking habit (OR: 1.45, 95% CI: 1.08-1.94), and polypharmacy at discharge (OR: 6.76, 95% CI: 4.15-11.0) were associated with adherence to guidelines. COPD was independently associated with the risk of cardiovascular and respiratory death and rehospitalization occurrence compared to patients without COPD during follow-up. Adherence to guidelines was inversely associated with the occurrence of death from all causes (OR: 0.12, 95% CI: 0.02-0.90). Conclusions/Implications: COPD was common in older patients acutely hospitalized, showing an impaired functional and clinical status. Prescriptions for older COPD patients were often not adherent to GOLD guidelines. Poor adherence to guidelines was associated with a worse clinical status.

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Adherence to COPD management guidelines in general practice? A review of the literature

Cited by 45 publications

References 24 publications

Adherence of North‐African Pulmonologists to the 2017‐Global Initiative for Chronic Obstructive Lung Disease (GOLD) Pharmacological Treatment Guidelines (PTGs) of Stable Chronic Obstructive Pulmonary Disease (COPD)

Adherence of North‐African Pulmonologists to the 2017‐Global Initiative for Chronic Obstructive Lung Disease (GOLD) Pharmacological Treatment Guidelines (PTGs) of Stable Chronic Obstructive Pulmonary Disease (COPD)

The impact of 2011 and 2017 Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) guidelines on allocation and pharmacological management of patients with COPD in Taiwan: Taiwan Obstructive Lung Disease (TOLD) study

Hospital Care of Older Patients With COPD: Adherence to International Guidelines for Use of Inhaled Bronchodilators and Corticosteroids

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