Guideline-based COPD management in a resource-limited setting — physicians' understanding, adherence and barriers: a cross-sectional survey of internal and family medicine hospital-based physicians in Nigeria

Desalu, Olufemi Olumuyiwa; Onyedum, Cajetan C; Adeoti, Adekunle Olatayo; Gundiri, Laguhyel B; Fadare, Joseph; Adekeye, Kehinde Adesola; Onyeri, Kelechi D; Fawibe, Ademola Emmanuel

doi:10.4104/pcrj.2013.00014

Cited by 44 publications

(54 citation statements)

References 20 publications

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“…Excellent knowledge of the current version of the GOLD recommendations among respiratory specialists and primary care physicians in Germany were repeatedly described by Glaab [18], [19]. A high level of knowledge of GOLD among respiratory specialists, and sufficient knowledge among family physicians and internists, was also demonstrated in Nigeria [20].…”

Section: Discussionmentioning

confidence: 88%

Real-Life GOLD 2011 Implementation: The Management of COPD Lacks Correct Classification and Adequate Treatment

Koblížek

Pecen²,

Zatloukal

et al. 2014

PLoS ONE

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Chronic obstructive pulmonary disease (COPD) is a serious, yet preventable and treatable, disease. The success of its treatment relies largely on the proper implementation of recommendations, such as the recently released Global Strategy for Diagnosis, Management, and Prevention of COPD (GOLD 2011, of late December 2011). The primary objective of this study was to examine the extent to which GOLD 2011 is being used correctly among Czech respiratory specialists, in particular with regard to the correct classification of patients. The secondary objective was to explore what effect an erroneous classification has on inadequate use of inhaled corticosteroids (ICS). In order to achieve these goals, a multi-center, cross-sectional study was conducted, consisting of a general questionnaire and patient-specific forms. A subjective classification into the GOLD 2011 categories was examined, and then compared with the objectively computed one. Based on 1,355 patient forms, a discrepancy between the subjective and objective classifications was found in 32.8% of cases. The most common reason for incorrect classification was an error in the assessment of symptoms, which resulted in underestimation in 23.9% of cases, and overestimation in 8.9% of the patients' records examined. The specialists seeing more than 120 patients per month were most likely to misclassify their condition, and were found to have done so in 36.7% of all patients seen. While examining the subjectively driven ICS prescription, it was found that 19.5% of patients received ICS not according to guideline recommendations, while in 12.2% of cases the ICS were omitted, contrary to guideline recommendations. Furthermore, with consideration to the objectively-computed classification, it was discovered that 15.4% of patients received ICS unnecessarily, whereas in 15.8% of cases, ICS were erroneously omitted. It was therefore concluded that Czech specialists tend either to under-prescribe or overuse inhaled corticosteroids.

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Section: Discussionmentioning

confidence: 88%

Real-Life GOLD 2011 Implementation: The Management of COPD Lacks Correct Classification and Adequate Treatment

Koblížek

Pecen²,

Zatloukal

et al. 2014

PLoS ONE

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“…In COPD, some specific variables, largely described by López-Campos et al [12], are associated with PTG adherence. Some of them are physician-(e.g., knowledge), patient-(e.g., understanding), and/or social-(e.g., costs of medication) related factors [17][18][19][20][21][22][23]. The Tunisian pulmonologists' adherence to the 2017-GOLD PTGs is influenced by the patients' age, SEL, national health insurance coverage, and GOLD groups ( Table 5).…”

Section: Discussion Of Results the Evaluation Of Pulmonologists'mentioning

confidence: 99%

Adherence of North-African Pulmonologists to the 2017-Global Initiative for Chronic Obstructive Lung Disease (GOLD) Pharmacological Treatment Guidelines (PTGs) of Stable Chronic Obstructive Pulmonary Disease (COPD)

Aissa

Knaz

Maatoug

et al. 2020

BioMed Research International

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Background. No previous study has investigated the adherence rate of North-African pulmonologists to the 2017-GOLD PTGs. Aims. To investigate the adherence rate of Tunisian pulmonologists to the 2017-GOLD PTGs and to identify the barriers to their adherence. Methods. This was a cohort study involving clinically stable COPD patients who presented to a pulmonology outpatient consultation. The patients were classified as having been appropriately and inappropriately (over- or undertreatment) treated for the GOLD group. Logistic regression was performed to determine the adherence barriers to the 2017-GOLD PTGs. Results. A total of 296 patients were included (88.1% males, mean age: 68±10 years; GOLD A (7.1%), B (36.1%), C (4.1%), and D (52.7%)). The pulmonologists’ adherence rate to the 2017-GOLD PTGs was 29.7%. There was a significant statistical difference between the adherence rates among the four GOLD groups (A: 19.0%, B: 20.6%, C: 8.3%, and D: 39.1%; p=0.001). Differences were statistically significant between the GOLD group D and groups B (p=0.001) and C (p=0.033). The multivariate analysis showed that age (odds ratio (OR): 0.968), socioeconomic level (high/medium vs. low; OR: 2.950), insurance type (national health insurance vs. others; OR: 2.851), and GOLD groups (A/B vs. C/D; OR: 3.009) significantly influenced the adherence rate to the 2017-GOLD PTGs. Conclusion. The adherence rate of Tunisian pulmonologists to the 2017-GOLD PTGs is low. It seems that the patients’ age, socioeconomic level, national health insurance coverage, and GOLD groups influenced their adherence.

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“…As demonstrated by the “Fluid Expansion As Supportive Therapy” trial and the multicountry evaluation of the Integrated Management of Childhood Illness materials, it is clear that high‐quality in‐context assessment to address the appropriateness and the effectiveness of both formal and informal acute care guidelines is feasible and informative . The majority of other studies in this domain focus on the evaluation of disease‐specific guidelines (e.g., chronic obstructive pulmonary disease, pneumonia, human immunodeficiency virus, and sepsis) as they pertain to resource‐limited settings, but with little dedicated research focused on patient‐oriented effectiveness outcomes in the unique setting of acute and emergency care and resuscitation . Even less work has focused on the challenging issue of transforming guidelines into accepted clinical practice—a critical intermediary step for well‐researched guidelines to actually affect clinical care.…”

Section: Assessing the Appropriateness And Effectiveness Of Local Andmentioning

confidence: 99%

Clinical and Translational Research in Global Health and Emergency Care: A Research Agenda

Runyon

Sawe

Levine

et al. 2013

Academic Emergency Medicine

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As policy-makers increasingly recognize emergency care to be a global health priority, the need for highquality clinical and translational research in this area continues to grow. As part of the proceedings of the 2013 Academic Emergency Medicine consensus conference, this article discusses the importance of: 1) including clinical and translational research in the initial emergency care development plan, 2) defining the burden of acute disease and the barriers to conducting research in resource-limited settings, 3) assessing the appropriateness and effectiveness of local and global acute care guidelines within the local context, 4) studying the local research infrastructure needs to understand the best methods to build a sustainable research infrastructure, and 5) studying the long-term effects of clinical research programs on health care systems.ACADEMIC EMERGENCY MEDICINE 2013; 20:1272-1277 by the Society for Academic Emergency Medicine A s policy-makers increasingly recognize emergency care to be a global health priority, the need for high-quality clinical and translational research in emergency care continues to grow. Often, when developing emergency care programs in resource-limited settings, the inclination is to focus on clinical and educational services given the relative lack of resources and personnel. However, clinical and translational research must also be seen as critical to the successful development of a sustainable emergency care infrastructure. 1 IMPORTANCE OF CLINICAL AND TRANSLATIONAL RESEARCH IN GLOBAL HEALTH AND EMERGENCY CAREConcurrent development of a research infrastructure within the emergency care system will serve to enhance care delivery and sustainability. As the initial focus is on improving emergency care, it is important to recognize that research is necessary to inform clinical care delivery. Just as the adult literature does not always translate to children, treatments or care delivery paradigms

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Guideline-based COPD management in a resource-limited setting — physicians' understanding, adherence and barriers: a cross-sectional survey of internal and family medicine hospital-based physicians in Nigeria

Abstract: Background: Few data exist on the understanding and adherence to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines in resource-limited settings, which are mostly in sub-Saharan Africa.

Cited by 44 publications

References 20 publications

Real-Life GOLD 2011 Implementation: The Management of COPD Lacks Correct Classification and Adequate Treatment

Real-Life GOLD 2011 Implementation: The Management of COPD Lacks Correct Classification and Adequate Treatment

Adherence of North-African Pulmonologists to the 2017-Global Initiative for Chronic Obstructive Lung Disease (GOLD) Pharmacological Treatment Guidelines (PTGs) of Stable Chronic Obstructive Pulmonary Disease (COPD)

Clinical and Translational Research in Global Health and Emergency Care: A Research Agenda

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