Guideline adherence in management of stable chronic obstructive pulmonary disease

Roozbeh Sharif, Christel R. Cuevas, Yue Wang, Mohit Arora, Gulshan Sharma

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Background Chronic obstructive pulmonary disease (COPD) is the only leading cause of death with rising morbidity and mortality. Clinical practice guidelines (CPGs) to optimize pharmacotherapy for patients with COPD have been updated based on promising results of randomized clinical trials. We examined the frequency of and factors associated with guideline adherence by physicians in clinical practice at an academic medical center. Methods Patients with a clinical diagnosis of COPD, confirmed by spirometry, who presented to the ambulatory clinics, were enrolled. The primary outcome was provider's adherence to the 2007 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Subjects were categorized as guideline-concordant who received a rescue inhaler (all patients), or at least one long-acting bronchodilator (stage II), or at least one long-acting bronchodilator plus an inhaled corticosteroid (stage III-IV). Demographics, clinical information and type of provider were recorded. Provider type was classified as primary care physician (PCP), pulmonologist, or co-management by both. Results Among 450 subjects who met study criteria, 246 (54.7%) received guideline-concordant treatment. Age, sex, race, disease severity, and co-morbidities were not associated with guideline adherence. Multivariate analysis showed that patients co-managed by a PCP and pulmonologist had a higher likelihood of receiving guideline-concordant treatment than those managed by one or the other (Odds Ratio: 4.59; 95% Confidence Interval: 2.92, 7.22, p < 0.001). Conclusions Just over half of stable COPD patients receive guideline-concordant care. Co-management by a PCP and pulmonologist increases the likelihood of receiving guideline-concordant inhaler therapy.

Original languageEnglish (US)
Pages (from-to)1046-1052
Number of pages7
JournalRespiratory Medicine
Volume107
Issue number7
DOIs
StatePublished - Jul 2013

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Guideline Adherence
Chronic Obstructive Pulmonary Disease
Guidelines
Primary Care Physicians
Nebulizers and Vaporizers
Bronchodilator Agents
Morbidity
Spirometry
Practice Guidelines
Cause of Death
Adrenal Cortex Hormones
Therapeutics
Multivariate Analysis
Randomized Controlled Trials
Odds Ratio
Demography
Confidence Intervals
Physicians
Drug Therapy
Mortality

Keywords

  • Bronchodilator
  • Chronic obstructive pulmonary disease
  • Clinical practice guidelines
  • Guideline adherence
  • Primary care physician

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Guideline adherence in management of stable chronic obstructive pulmonary disease. / Sharif, Roozbeh; Cuevas, Christel R.; Wang, Yue; Arora, Mohit; Sharma, Gulshan.

In: Respiratory Medicine, Vol. 107, No. 7, 07.2013, p. 1046-1052.

Research output: Contribution to journalArticle

Sharif, Roozbeh ; Cuevas, Christel R. ; Wang, Yue ; Arora, Mohit ; Sharma, Gulshan. / Guideline adherence in management of stable chronic obstructive pulmonary disease. In: Respiratory Medicine. 2013 ; Vol. 107, No. 7. pp. 1046-1052.
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abstract = "Background Chronic obstructive pulmonary disease (COPD) is the only leading cause of death with rising morbidity and mortality. Clinical practice guidelines (CPGs) to optimize pharmacotherapy for patients with COPD have been updated based on promising results of randomized clinical trials. We examined the frequency of and factors associated with guideline adherence by physicians in clinical practice at an academic medical center. Methods Patients with a clinical diagnosis of COPD, confirmed by spirometry, who presented to the ambulatory clinics, were enrolled. The primary outcome was provider's adherence to the 2007 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Subjects were categorized as guideline-concordant who received a rescue inhaler (all patients), or at least one long-acting bronchodilator (stage II), or at least one long-acting bronchodilator plus an inhaled corticosteroid (stage III-IV). Demographics, clinical information and type of provider were recorded. Provider type was classified as primary care physician (PCP), pulmonologist, or co-management by both. Results Among 450 subjects who met study criteria, 246 (54.7{\%}) received guideline-concordant treatment. Age, sex, race, disease severity, and co-morbidities were not associated with guideline adherence. Multivariate analysis showed that patients co-managed by a PCP and pulmonologist had a higher likelihood of receiving guideline-concordant treatment than those managed by one or the other (Odds Ratio: 4.59; 95{\%} Confidence Interval: 2.92, 7.22, p < 0.001). Conclusions Just over half of stable COPD patients receive guideline-concordant care. Co-management by a PCP and pulmonologist increases the likelihood of receiving guideline-concordant inhaler therapy.",
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