Mapping of Modifiable Factors with Interdisciplinary Chronic Obstructive Pulmonary Disease (COPD) Guidelines Adherence to the Theoretical Domains Framework: A Systematic Review

Abstract

Background: COPD guidelines non-concordance is a challenge frequently highlighted by respiratory experts. Despite the provision of comprehensive evidence-based national and international guidelines, the COPD burden to frontline healthcare services has increased in the last decade. Suboptimal guidelines concordance can be disruptive to health-related quality of life (HRQoL), hastening pulmonary function decline and surging overall morbidity and mortality. A lack of concordance with guidelines has created an escalating economic burden on health-care systems. Identifying interdisciplinary interventions to facilitate improved adherence to guidelines may significantly reduce re-admissions, enhance HRQoL amongst patients and their families, and facilitate economic efficiency. Materials and Methods: This review adhered to the Joanna Briggs Institute (JBI) methodology for mixed methods systematic reviews and the PRISMA ScR reporting guidelines. Two independent reviewers screened abstracts and full text articles in consonance with inclusion criteria. The convergent integrative JBI method collated quantitative, qualitative and mixed methods studies from nine databases. JBI critical appraisal tools were utilised to assess the quality of research papers. The theoretical domains framework (TDF) along with a specifically developed COPD data extraction tool were adopted as a priori to collect and collate data. Identified barriers and corresponding clinical behavioural change solutions were categorised using TDF domains and behavior change wheel (BCW) to provide future research and implementation recommendations. Results: Searches returned 1068 studies from which 37 studies were included (see Figure 1). COPD recommendations identified to be discordant with clinical practice included initiating non-invasive ventilation, over-or under-prescription of corticosteroids and antibiotics, and a lack of discharging patients with a smoking cessation plan or pulmonary rehabilitation. TDF domains with highest frequency scores were knowledge, environmental resources, and clinical behaviour regulation. Electronic order sets/digital proforma with guideline resources at point of care and easily accessible digital community referrals to target both pharmacological and non-pharmacological management appear to be a solution to improve concordance. Conclusion: Implementation of consistent quality improvement intervention within hospitals for patients with COPD may exclude any implementation gap and prevent readmissions. Electronic proformas with digital referrals will assist with future evaluation audits to prioritise and target interventions to improve guidelines concordance. Ethics and Dissemination: Ethical approval is not required, and results dissemination will occur through peer-reviewed publication. PROSPERO Registration Number: CRD42020156267.

Bufei Decoction Improves Lung-Qi Deficiency Syndrome of Chronic Obstructive Pulmonary Disease in Rats by Regulating the Balance of Th17/Treg Cells

“…COPD, with airway obstruction as the main pathological change, is a clinically representative chronic respiratory disease, and progressively threatens life and health, and is considered to be a major global medical burden [ 17 ]. Therefore, the pathogenesis of COPD needs to be revealed and new preventive and therapeutic methods should be explored.…”

“…e normal tissues of the respiratory tract are continuously in ltrated and destroyed by chronic in ammation, resulting in airway remodeling and stenosis, causing small airway obstruction and increased mucus secretion in the lung tissue [6]. e imbalance of T helper cell 17 ( 17)/regulatory T-cells (Treg) is a vital factor in inducing COPD development [7]. e in ammatory response aggravation in stable COPD patients' lower respiratory tract and lungs is aggravated, which is related to the enhanced expression of key 17 cytokines, interleukin (IL)-6, and IL-17.…”

Development of an Electronic Interdisciplinary Chronic Obstructive Pulmonary Disease (COPD) Proforma (E-ICP) to Improve Interdisciplinary Guideline Adherence in the Emergency Department: Modified Delphi Study

“…Lack of availability of spirometry results in the emergency department were suggested to be tackled by utilising modified Medical Research Council (mMRC) dyspnoea scores and cigarette smoking/smoke exposure assumption in ED which had minimal consensus by both ED and respiratory department clinicians which is an area that needs further research. 25 , 29 Interdisciplinary staff consistently agreed upon COPD patients bringing forward documentation with their last baseline pulmonary function measures in primary care to assist with early identification of probable hypercapnic respiratory failure.…”

“…Summarising the indicators of care in ED and referrals being managed by a single point of contact to respiratory clinical nurse the proforma will provide consistent guideline adherence and capture ED discharges for continuous care. 5 , 25 The electronic proforma will be potentially capable of facilitating chronic care support appropriately through community or outpatients referrals. Electronic proformas are only feasible in larger hospitals with intranet resources and fall short when discussing rural and remote hospitals where there are no medical or nursing respiratory specialists.…”

“…This modified Delphi approach used a mixed-method design utilising quantitative survey questions and qualitative thematic analysis to develop a COPD proforma with specific clinical-driven content for ED. Most important indicators of care in the ED were selected (a set of evidence-based interventions applied to improve clinical outcomes) involving three phases: (1) a systematic literature review to assess barriers and solutions for guideline adherence, 25 (2) a modified Delphi panel to select interventions for the bundle, and (3) consensus process through three rounds of scoring quantitative survey and qualitative thematic analysis on each indicator (see Figure 1 ). An E-Delphi technique appeared to be the most suitable method to gain consensus among emergency department and respiratory department interdisciplinary experts to develop and determine content validity and realistic implementation probability of the E-ICP considering the primary aim was to increase guideline adherence utilising E-ICP.…”