Adherence to GOLD Recommendations among Swiss Pulmonologists and General Practitioners

Marmy, Joana; Diedrich, Jens Peter; Cadus, Cordula; Grendelmeier, Peter; Tschacher, Anne; Dieterle, Thomas; Chhajed, Prashant N.; Leüppi, Jörg D.

doi:10.1080/15412555.2020.1859469

Cited by 10 publications

(13 citation statements)

References 19 publications

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“…The sociodemographic profile of our study sample is also remarkably close to that reported by other similar studies. Finally, other studies -similarly to ours-report the best adherence to GOLD 2017 treatment guidelines for Group D and increasing overprescribing practices as we move to previous groups [18][19][20][21].…”

Section: Discussionsupporting

confidence: 70%

“…ICS: inhaled corticosteroids, LABA: long-acting β adrenoreceptor agonists, LAMA: long-acting muscarinic receptor antagonists, #: 2 bronchodilators of the same type plus ICS, ##: 3 or more bronchodilators patients), Tudoric et al [17] from a sample of over 3300 patients from central and eastern Europe, and Duartede-Araújo et al [18] in Portugal (in a sample of over 300 patients), although higher percentages have been also reported [19]. In the great majority of studies, just like in our work, group C is the smallest among the four groups of the ABCD system [16][17][18][20][21][22], group B the biggest followed (in a few cases exceeded) by group D [16][17][18][19][20][21][22]. The sociodemographic profile of our study sample is also remarkably close to that reported by other similar studies.…”

Section: Discussionsupporting

confidence: 57%

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Classification of COPD patients and compliance to recommended treatment in Greece according to GOLD 2017 report: the RELICO study

et al. 2021

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Background Chronic obstructive pulmonary disease (COPD) is a multifactorial clinical condition, characterized by chronic progressive (or worsening) respiratory symptoms, structural pulmonary abnormalities, and impaired lung function, and is often accompanied by multiple, clinically significant comorbid disorders. In 2017, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) issued a new report on COPD prevention, diagnosis and management, aiming at personalizing the maintenance therapeutic approach of the stable disease, based on the patients’ symptoms and history of exacerbations (ABCD assessment approach). Our objective was to evaluate the implementation of GOLD suggestions in everyday clinical practice in Greece. Methods This was a cross-sectional observational study. Sixty-five different variables (demographics, vital sign measurements, COPD-related medical history parameters, comorbidities, vaccination data, COPD severity based on spirometry measurements, COPD stage based on the ABCD assessment approach, COPD treatments) were collected from 3615 nation-wide COPD patients (Greece). Results The mean age at the time of initial COPD diagnosis was 63.8 (± 10.2). Almost 60% of the subjects were classified into group B, while the remaining patients were falling into groups A (18%) and D (21%), and only a small minority of patients belonged to Group C, according to the ABCD assessment approach. The compliance of respiratory physicians to the GOLD 2017 therapeutic suggestions is problematic, especially when it comes to COPD patients belonging to Group A. Conclusion Our data provide valuable information regarding the demographic and medical profile of COPD patients in Greece, the domains which the revised ABCD assessment approach may show some clinical significance on, and the necessity for medical practitioners dealing with COPD patients to adhere closer to international recommendations for the proper management of the disease.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionsupporting

confidence: 57%

Classification of COPD patients and compliance to recommended treatment in Greece according to GOLD 2017 report: the RELICO study

et al. 2021

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“…The adoption of GOLD recommendations in clinical practice is challenging and significantly variable: in Germany, most lung specialists increased their adherence to updated guideline recommendations over time, 8 but other reports across Europe were less enthusiastic. [9][10][11][12] Moreover, the adoption of GOLD guidelines seems to be particularly insufficient in primary healthcare. [13][14][15][16][17][18] These studies indicated that misdiagnosis, poor use of spirometry, insufficient symptom evaluation, and misalignment of treatment regimens with GOLD recommendations are common and primarily explained by the lack of awareness of the GOLD initiative.…”

Section: Introductionmentioning

confidence: 99%

Are We Missing the Opportunity to Disseminate GOLD Recommendations Through AECOPD Discharge Letters?

Vukić Dugac,

Vergles,

Škrinjarić Cincar

et al. 2023

COPD

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Introduction Acute exacerbations in chronic obstructive pulmonary disease (AECOPD) lead to poor outcomes and increased burden for patients and healthcare systems. The Global Initiative for COPD (GOLD) includes specific recommendations for AECOPD interventions, discharge criteria, and follow-up. Aligning the AECOPD discharge letters (DL) with GOLD guidelines could facilitate dissemination of recommendations among general practitioners (GPs). Purpose This study was conducted to assess the compliance of DL with the GOLD recommendations in Croatia. Methods Pre-pandemic DL of patients presenting for AECOPD to emergency room (ER) were analyzed and stratified by clinical decision to hospitalize (HDL) or discharge patients for outpatient treatment (ERDL). Experienced pulmonologists checked the information from DL against guidelines by using online study-specific questionnaires. Results In total, 225 HDL and 368 ERDL were analyzed. In most cases, the GOLD ABCD categories (85% HDL, 92% ERDL) or the spirometry-based degree of severity (90% HDL, 91% ERDL) were not included. The number of AEs in the previous year was recorded, but the specific frequent exacerbator phenotype not explicitly stated. The AE phenotype was included in two thirds of HDL and one third of ERDL. The blood eosinophil count was frequently available, but not considered decision-relevant information. Adjustments of previous maintenance therapy, mostly escalation, were recommended in 58.4% HDL and 27.9% ERDL, respectively. Education on proper use of inhalers was recommended only in 15.6% of HDL. Smoking cessation measures were advised in 23.1% HDL and 7.9% ERDL; pulmonary rehabilitation in 35.6% HDL and 0.8% ERDL. Early follow-up was frequently advised (>50%), but rarely appointed. Conclusion Significant deficiencies in compliance with the GOLD guidelines were identified, translating into a missed opportunity for GPs to become acquainted with GOLD recommendations. These findings emphasize the necessity to increase compliance with guidelines first at specialist level and consequent standardization of DL.

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“…The disease is an increasing cause of morbidity and mortality, in contrast to other major chronic diseases [2]. With a global prevalence of approximately 11.7%, COPD is considered the fourth leading cause of death worldwide [3]. COPD is also associated with a significant economic burden by producing an annual cost of nearly 50 billion Euros in the EU [2].…”

Section: Introductionmentioning

confidence: 99%

“…It remains unclear how much the integration of GOLD guidelines affects the clinical outcomes of COPD patients. Although patient-reported outcome questionnaires like the CAT and the mMRC are necessary to assess the severity of the disease and to categorise patients correctly so that they receive the recommended treatments, it seems that a majority of physicians in real practice settings do not use these questionnaires [3]. This might lead to physicians underestimating symptoms and thus not adjusting therapy as might be necessary.…”

Section: Introductionmentioning

confidence: 99%

Clinical characteristics governing treatment adjustment in COPD patients: results from the Swiss COPD cohort study

Kleinsorge,

Pasha,

Boesing

et al. 2023

Swiss Med Wkly

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BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a widespread chronic disease characterised by irreversible airway obstruction [1]. Features of clinical practice and healthcare systems for COPD patients can vary widely, even within similar healthcare structures. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy is considered the most reliable guidance for the management of COPD and aims to provide treating physicians with appropriate insight into the disease. COPD treatment adaptation typically mirrors the suggestions within the GOLD guidelines, depending on how the patient has been categorised. However, the present study posits that the reasons for adjusting COPD-related treatment are hugely varied. OBJECTIVES: The objective of this study was to assess the clinical symptoms that govern both pharmacological and non-pharmacological treatment changes in COPD patients. Using this insight, the study offers suggestions for optimising COPD management through the implementation of GOLD guidelines. METHODS: In this observational cohort study, 24 general practitioners screened 260 COPD patients for eligibility from 2015–2019. General practitioners were asked to collect general information from patients using a standardised questionnaire to document symptoms. During a follow-up visit, the patient’s symptoms and changes in therapy were assessed and entered into a central electronic database. Sixty-five patients were removed from the analysis due to exclusion criteria, and 195 patients with at least one additional visit within one year of the baseline visit were included in the analysis. A change in therapy was defined as a change in either medication or non-medical treatment, such as pulmonary rehabilitation. Multivariable mixed models were used to identify associations between given symptoms and a step up in therapy, a step down, or a step up and a step down at the same time. RESULTS: For the 195 patients included in analyses, a treatment adjustment was made during 28% of visits. In 49% of these adjustments, the change in therapy was a step up, in 33% a step down and in 18% a step up (an increase) of certain treatment factors and a step down (a reduction) of other prescribed treatments at the same time. In the multivariable analysis, we found that the severity of disease was linked to the probability of therapy adjustment: patients in GOLD Group C were more likely to experience an increase in therapy compared to patients in GOLD Group A (odds ratio [OR] 3.43 [95% confidence interval {CI}: 1.02–11.55; p = 0.135]). In addition, compared to patients with mild obstruction, patients with severe (OR 4.24 [95% CI: 1.88–9.56]) to very severe (OR 5.48 [95% CI: 1.31–22.96]) obstruction were more likely to experience a therapy increase (p <0.0001). Patients with comorbidities were less likely to experience a treatment increase than those without (OR 0.42 [95% CI: 0.24–0.73; p = 0.002]). A therapy decrease was associated with both a unit increase in COPD Assessment Test (CAT) score (OR 1.07 [95% CI: 1.01–1.14; p = 0.014]) and having experienced an exacerbation (OR 2.66 [95% CI: 1.01–6.97; p = 0.047]). The combination of steps up as well as steps down in therapy was predicted by exacerbation (OR 8.93 [95% CI: 1.16–68.28; p = 0.035]) and very severe obstruction (OR 589 [95% CI: 2.72 – >999; p = 0.109]). CONCLUSIONS: This cohort study provides insight into the management of patients with COPD in a primary care setting. COPD Group C and airflow limitation GOLD 3–4 were both associated with an increase in COPD treatment. In patients with comorbidities, there were often no treatment changes. Exacerbations did not make therapy increases more probable. The presence of neither cough/sputum nor high CAT scores was associated with a step up in treatment.

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Adherence to GOLD Recommendations among Swiss Pulmonologists and General Practitioners

Cited by 10 publications

References 19 publications

Classification of COPD patients and compliance to recommended treatment in Greece according to GOLD 2017 report: the RELICO study

Classification of COPD patients and compliance to recommended treatment in Greece according to GOLD 2017 report: the RELICO study

Are We Missing the Opportunity to Disseminate GOLD Recommendations Through AECOPD Discharge Letters?

Clinical characteristics governing treatment adjustment in COPD patients: results from the Swiss COPD cohort study

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