Advertisement

Irish Journal of Medical Science (1971 -)

, Volume 187, Issue 2, pp 403–407 | Cite as

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

  • J. SehlEmail author
  • J. O’Doherty
  • R. O’Connor
  • B. O’Sullivan
  • A. O’Regan
Review Article

Abstract

Background

Chronic obstructive pulmonary disease (COPD) is a progressive illness that is mostly managed in the general practice setting. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines are the international gold standard, and it is important to understand how these are being applied in general practice.

Aims

This review aimed to assess the current level of adherence to international best practice guidelines among general practitioners in relation to COPD.

Methods

PubMed and EMBASE searches (from 2012 to 2016) were performed and used the search terms guidelines, COPD, general practitioners, and primary care. Papers were excluded if they were not primary sources, were published before 2012, or did not pertain to a general practice setting.

Results

After applying set inclusion and exclusion criteria, 11 studies were retrieved. These papers were grouped under three categories: diagnosis, pharmacological, and non-pharmacological management, based on the GOLD guidelines.

Conclusions

Current studies show significant variability in adherence to the GOLD guidelines. Barriers identified include lack of clarity, unfamiliarity with recommendations, and lack of familiarity with the guidelines. If general practice is expected to manage COPD and other chronic diseases, health service investment is needed to provide appropriate focused guidelines, to support their dissemination and resources to implement them in practice.

Keywords

Adherence COPD Educational General practitioners GOLD guidelines Management 

Notes

Compliance with ethical standards

Funding

No external funding

Conflict of interests

The authors declare that they have no conflict of interest.

Ethical approval

Ethical approval was not required for this review.

Supplementary material

11845_2017_1651_MOESM1_ESM.docx (15 kb)
Supplementary Table 2 (DOCX 15 kb)

References

  1. 1.
    Murphy LA, Harrington P, Taylor SJ et al (2017) Clinical-effectiveness of self-management interventions in chronic obstructive pulmonary disease: an overview of review. Chron Respir Dis:1–13. doi: 10.1177/1479972316687208
  2. 2.
    Adeloye D, Chua S, Lee C et al (2015) Global and regional estimates of COPD prevalence: systematic review and meta–analysis. Glob J Health Sci 5(2). doi: 10.7189/jogh.05-020415
  3. 3.
    Naquvi M, Khachi H (2016) The barriers to accessing primary care resulting in hospital presentation for exacerbation of asthma or chronic obstructive pulmonary disease in a large teaching hospital in London. Respir Med 117. doi: 10.1016/j.rmed.2016.05.020
  4. 4.
    Government of Ireland (2001) Primary Care-A New Direction. 1–64. http://health.gov.ie/wp-content/uploads/2014/03/primcare-report.pdf. Accessed 21 Apr 2017
  5. 5.
    Wagner EH (2000) The role of patient care teams in chronic disease management. BMJ 320:569–572. doi: 10.1136/bmj.320.7234.569 CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Sopcak N, Aguilar C, O’Brien MA et al (2016) Implementation of the BETTER 2 program: a qualitative study exploring barriers and facilitators of a novel way to improve chronic disease prevention and screening in primary care. Implement Sci 11:158. doi: 10.1186/s13012-016-0525-0 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Global Initiative for Chronic Obstructive Lung Disease (2017) GOLD 2017 Global Strategy for the Diagnosis, Management and Prevention of COPD http://goldcopd.org/gold-2017-global-strategy-diagnosis-management-prevention-copd/. Accessed 18 Apr 2017
  8. 8.
    Pauwels R, Buist A, Calverley P et al (2001) Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 163(5):1256–1276. doi: 10.1164/ajrccm.163.5.2101039 CrossRefPubMedGoogle Scholar
  9. 9.
    Raluy-Callado M, Lambrelli D, MacLachlan S et al (2015) Epidemiology, severity, and treatment of chronic obstructive pulmonary disease in the United Kingdom by GOLD 2013. Int J Chron Obstruct Pulmon Dis:925. doi: 10.2147/COPD.S82064
  10. 10.
    Maio S, Baldacci S, Martini F et al (2014) COPD management according to old and new GOLD guidelines: an observational study with Italian general practitioners. Curr Med Res Opin 30:1033–1042. doi: 10.1185/03007995.2014.884492 CrossRefPubMedGoogle Scholar
  11. 11.
    Montes de Oca M, Lopez Varela MV, Laucho-Contreras ME et al (2017) Classification of patients with chronic obstructive pulmonary disease according to the Latin American Thoracic Association (ALAT) staging systems and the global initiative for chronic obstructive pulmonary disease (GOLD). Arch Bronconeumol 53(3):98–106. doi: 10.1016/j.arbres.2016.08.015 PubMedGoogle Scholar
  12. 12.
    Sanguinetti CM, De Benedetto F, Donner CF et al (2014) Pneumocafé project: an inquiry on current COPD diagnosis and management among general practitioners in Italy through a novel tool for professional education. Multidiscip Respir Med 9(1):35. doi: 10.1186/2049-6958-9-35 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    UIC (2017) Evidence Based Medicine (PICO) http://researchguides.uic.edu/c.php?g=252338&p=3954402. Accessed 18 Apr 2017
  14. 14.
    Belletti D, Liu J, Zacker C et al (2013) Results of the CAPPS: COPD–assessment of practice in primary care study. Curr Med Res Opin 29:957–966. doi: 10.1185/03007995.2013.803957 CrossRefPubMedGoogle Scholar
  15. 15.
    Kaufmann C, Markun S, Hasler S et al (2015) Performance measures in the management of chronic obstructive pulmonary disease in primary care—a retrospective analysis. Praxis 104:897–907. doi: 10.1024/1661-8157/a002101 CrossRefPubMedGoogle Scholar
  16. 16.
    Davis KJ, Landis SH, Oh YM et al (2015) Continuing to Confront COPD International Physician Survey: physician knowledge and application of COPD management guidelines in 12 countries. Int J Chron Obstruct Pulmon Dis 10:39. doi: 10.2147/COPD.S70162 PubMedGoogle Scholar
  17. 17.
    Perez X, Wisnivesky JP, Lurslurchachai L et al (2012) Barriers to adherence to COPD guidelines among primary care providers. Respir Med 106:374–381. doi: 10.1016/j.rmed.2011.09.010 CrossRefPubMedGoogle Scholar
  18. 18.
    Brusselle G, Price D, Gruffydd-Jones K et al (2015) The inevitable drift to triple therapy in COPD: an analysis of prescribing pathways in the UK. Int J Chron Obstruct Pulmon Dis 10:2207. doi: 10.2147/COPD.S91694 PubMedPubMedCentralGoogle Scholar
  19. 19.
    Bertella E, Zadra A, Vitacca M (2013) COPD management in primary care: is an educational plan for GPs useful? Multidiscip Respir Med 8:1. doi: 10.1186/2049-6958-8-24 CrossRefGoogle Scholar
  20. 20.
    Bereznicki BJ, Walters EH, Walters J et al (2016) Under-utilization of COPD management guidelines in Australian general practice. Respirol 21(142). doi: 10.1111/resp.12755
  21. 21.
    Sandelowsky H, Hylander I, Krakau I et al (2016) Time pressured deprioritization of COPD in primary care: a qualitative study. Scand J Prim Health Care 34:55–65. doi: 10.3109/02813432.2015.1132892 CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Cabrera C, Casanova C, Martín Y et al (2016) Agreement between a simple dyspnea-guided treatment algorithm for stable COPD and the GOLD guidelines: a pilot study. Int J Chron Obstruct Pulmon Dis 11:1217. doi: 10.2147/COPD.S100853 CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Foster F, Piggott R, Riley L et al (2016) Working with primary care clinicians and patients to introduce strategies for increasing referrals for pulmonary rehabilitation. Prim Health Care Res Dev 17(3):226–237. doi: 10.1017/S1463423615000286 CrossRefPubMedGoogle Scholar
  24. 24.
    Castillo D, Burgos F, Guayta R et al (2015) Airflow obstruction case finding in community-pharmacies: a novel strategy to reduce COPD underdiagnosis. Respir Med 109:475–482. doi: 10.1016/j.rmed.2015.02.009 CrossRefPubMedGoogle Scholar
  25. 25.
    Overington JD, Huang YC, Abramson MJ et al (2014) Implementing clinical guidelines for chronic obstructive pulmonary disease: barriers and solutions. J Thorac Dis. doi: 10.3978/j.issn.2072-1439.2014.11.25
  26. 26.
    Ulrik CS, Sørensen TB, Højmark TB et al (2013) Adherence to COPD guidelines in general practice: impact of an educational programme delivered on location in Danish general practices. Prim Care Respir J 22(1):23–28. doi: 10.4104/pcrj.2012.00089 CrossRefPubMedGoogle Scholar
  27. 27.
    Owens M, McCarthy T, O'Connor M (2009) Management of Chronic Obstructive Pulmonary Disease in General Practice http://www.icgp.ie/go/library/catalogue/item?spId=B185A124-7AF6-46ED-BCC88EA88166D56C. Accessed 19 Apr 2017

Copyright information

© Royal Academy of Medicine in Ireland 2017

Authors and Affiliations

  1. 1.University of Limerick Graduate Entry Medical SchoolLimerickIreland
  2. 2.Deenagh Medical PracticeKillarneyIreland

Personalised recommendations