Barriers to adherence to chronic obstructive pulmonary disease guidelines by primary care physicians

Abstract

Purpose:Even with the dissemination of several clinical guidelines, chronic obstructive pulmonary disease (COPD) remains underdiagnosed and mismanaged by many primary care physicians (PCPs). The objective of this study was to elucidate barriers to consistent implementation of COPD guidelines.Patients and methods:A cross-sectional study implemented in July 2008 was designed to assess attitudes and barriers to COPD guideline usage.Results:Five hundred US PCPs (309 family medicine physicians, 191 internists) were included in the analysis. Overall, 23.6% of the surveyed PCPs reported adherence to spirometry guidelines over 90% of the time; 25.8% reported adherence to guidelines related to long-acting bronchodilator (LABD) use in COPD patients. In general, physicians were only somewhat familiar with COPD guidelines, and internal medicine physicians were significantly more familiar than family physicians (P < 0.05). In a multivariate model controlling for demographics and barriers to guideline adherence, we found significant associations with two tested guideline components. Adherence to spirometry guidelines was associated with agreement with guidelines, confidence in interpreting data, ambivalence to outcome expectancy, and ability to incorporate spirometry into patient flow. Adherence to LABD therapy guidelines was associated with agreement with guidelines and confidence in gauging pharmacologic response.Conclusions:Adherence to guideline recommendations of spirometry use was predicted by agreement with the recommendations, self-efficacy, perceived outcome expectancy if recommendations were adhered to, and resource availability. Adherence to recommendations of LABD use was predicted by agreement with guideline recommendations and self-efficacy. Increasing guideline familiarity alone may have limited patient outcomes, as other barriers, such as low confidence and outcome expectancy, are more likely to impact guideline adherence.

Management of COPD in the UK primary-care setting: an analysis of real-life prescribing patterns

“…Further, the study by Salinas et al39 found that physicians who have difficulty assessing response to therapy were less likely to adhere to recommendations on long-acting bronchodilator use. As suggested by the authors of the study, this may be because long-acting bronchodilators produce subtle but meaningful improvements, which can be difficult for physicians to recognize 39. Moreover, physicians may not recognize a benefit of therapy in individual patients who have infrequent exacerbations, as decreased frequency of exacerbations is an important measure of the efficacy of inhaled therapies.…”

The Association of Weight With the Detection of Airflow Obstruction and Inhaled Treatment Among Patients With a Clinical Diagnosis of COPD

“…20,21 Salinas et al 21 showed that only one of four primary care physicians adhered . 90% of the time to guideline recommendations regarding spirometry or long-acting bronchodilator use.…”

Subutilization of COPD Guidelines in Primary Care

“…12 These evidence-based resources are free and easily accessible via the Internet, and many have been recently issued or updated, integrating new scientific findings and reflecting the availability of emerging therapeutic options. 13 One of the barriers for an evidence-based approach to COPD by general practitioners in Mexico is the limited awareness of these guidelines among primary care physicians; in our survey, just 60% of the PCPs responded that they use a clinical guideline for diagnosis and treatment of COPD, with GOLD being the most frequently referenced; 40% of those surveyed did not use a guideline because they were unaware of their existence. Also, almost 13% mentioned that they use the GINA asthma guideline to treat their COPD patients, and some PCPs answered they use the assessment questionnaire CAT as a guideline.…”