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Compliance of Pharmacotherapy with GOLD Guidelines: A Longitudinal Study in Patients with COPD

Grewe, Fabian A; Sievi, Noriane A; Bradicich, Matteo; Roeder, Maurice; Brack, Thomas; Brutsche, Martin H; Frey, Martin; Irani, Sarosh; Leuppi, Jörg D; Thurnheer, Robert; Clarenbach, Christian F; Kohler, Malcolm (2020). Compliance of Pharmacotherapy with GOLD Guidelines: A Longitudinal Study in Patients with COPD. International Journal of COPD, 1:627-635.

Abstract

Objective: To evaluate the clinical implementation of pharmacotherapy recommendations for chronic obstructive pulmonary disease (COPD) based on the Global Initiative for chronic obstructive lung disease (GOLD) guidelines, in a longitudinal setting.

Methods: This is a sub-analysis of a prospective, non-interventional cohort study including patients with confirmed mild-to-very-severe COPD from seven pulmonary outpatient clinics in Switzerland. Follow-up visits took place annually for up to 7 years, from October 2010 until December 2016. For each visit, we evaluated the compliance of the prescribed pharmacotherapy with the concurrently valid GOLD guideline. We investigated whether step-ups or step-downs in GOLD stage or risk-group were accompanied by concordant changes in prescribed medication. Groups were compared via ANOVA.

Results: Data of 305 patients (62±7 years, 66% men) were analysed. In 59.1% of visits, the prescribed medication conformed to the respective valid GOLD-guideline. Patients with very severe COPD were most likely to receive pharmacotherapy in compliance with guidelines. Step-ups and step-downs in risk group, requiring escalation, or de-escalation of pharmacotherapy, were noticed in 24 and 43 follow-up visits, respectively. Step-ups were adequately implemented in 4 (16.7%) and step-downs in six cases (14.0%).

Conclusion: The compliance of COPD-pharmacotherapy with GOLD-guidelines is suboptimal, especially in lower risk groups. The high rates of missed out treatment-adjustments suggest that the familiarity of physicians with guidelines leaves room for improvement.

Keywords: Global Initiative for Chronic Obstructive Lung Disease guidelines; chronic obstructive pulmonary disease; guideline-compliance.

Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Pneumology
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Pulmonary and Respiratory Medicine
Health Sciences > Health Policy
Health Sciences > Public Health, Environmental and Occupational Health
Uncontrolled Keywords:Public Health, Environmental and Occupational Health, Health Policy, Pulmonary and Respiratory Medicine, General Medicine
Language:English
Date:1 March 2020
Deposited On:03 Dec 2020 10:28
Last Modified:24 Oct 2024 01:37
Publisher:Dove Medical Press Ltd.
ISSN:1176-9106
OA Status:Gold
Free access at:PubMed ID. An embargo period may apply.
Publisher DOI:https://doi.org/10.2147/copd.s240444
PubMed ID:32273691
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