Does practice follow evidence-based guidelines? Adherence to GOLD guidelines in Portugal

Rodrigues, Cidália; Alfaro, Tiago M.; Fernandes, L. Dr; Ferreira, Pedro Gonçalo; Silva, S.; Costa, J C; Fernandes, Vera; Seixas, Eduarda; Viana, Ricardo

doi:10.1016/j.pulmoe.2019.02.011

Cited by 5 publications

(3 citation statements)

References 2 publications

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“…This study aimed to understand current practice, attitudes and rationales in COPD management in both primary and secondary care in six European countries. The study results were in line with other real-world cohorts [18][19][20][21][22] .…”

Section: Discussionsupporting

confidence: 90%

Investigating the rationale for COPD maintenance therapy prescription across Europe, findings from a multi-country study

Kocks

Ferreira

Schayck³

et al. 2022

Preprint

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This study aims to understand healthcare professionals’ thoughts and motivations about optimal management and treatment of patients with Chronic Obstructive Pulmonary Disease (COPD). We conducted a DELPHI survey through an online questionnaire distributed to 220 panellists from six European countries and a discrete choice experiment to describe the relationship between selected clinical criteria and the initial COPD treatment of choice. 127 panellists (general practitioners [GPs] and pulmonologists) completed the survey. Despite the familiarity and use (89.8%) of the GOLD classification for initial treatment selection, a frequent use of LAMA/LABA/ICS was noted. In fact, panellists agreed that inhaled corticosteroids (ICS) are over-prescribed in the primary care setting. Our study showed that GPs felt less confident than pulmonologists with ICS withdrawal. This mismatch observed between best practice and behaviour indicates the need to increase awareness and efforts to improve the adherence to guidelines in clinical practice.

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Section: Discussionsupporting

confidence: 90%

Investigating the rationale for COPD maintenance therapy prescription across Europe, findings from a multi-country study

Kocks

Ferreira

Schayck³

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 90%

Investigating the rationale for COPD maintenance therapy prescription across Europe, findings from a multi-country study

Kocks

Ferreira

Bakke

et al. 2023

npj Prim. Care Respir. Med.

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This study aims to understand healthcare professionals’ thoughts and motivations about optimal management and treatment of patients with chronic obstructive pulmonary disease (COPD). We conducted a DELPHI survey through an online questionnaire distributed to 220 panellists from six European countries and a discrete choice experiment to describe the relationship between selected clinical criteria and the initial COPD treatment of choice. One hundred twenty-seven panellists (general practitioners [GPs] and pulmonologists) completed the survey. Despite the familiarity and use (89.8%) of the GOLD classification for initial treatment selection, a frequent use of LAMA/LABA/ICS was noted. In fact, panellists agreed that inhaled corticosteroids (ICS) are over-prescribed in the primary care setting. Our study showed that GPs felt less confident than pulmonologists with ICS withdrawal. This mismatch observed between best practice and behaviour indicates the need to increase awareness and efforts to improve the adherence to guidelines in clinical practice.

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“…Even though the GOLD guidelines are well communicated, publicly available, and updated every year, their implementation in primary practice is not consistent. Previous studies indicated an insufficient adherence of general practitioners (GPs) to the GOLD guidelines [13][14][15][16][17]. COPD diagnosis and the monitoring of the development of the disease is often challenging, wherefore it demands confirmation using spirometry [9].…”

Section: Introductionmentioning

confidence: 99%

Adherence to the GOLD Guidelines in Primary Care: Data from the Swiss COPD Cohort

Mangold,

Boesing,

Berset

et al. 2023

JCM

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(1) Introduction: Chronic obstructive pulmonary disease (COPD) and its associated morbidity and mortality are a global burden on both affected patients and healthcare systems. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) issues guidelines with the aim of improving COPD management. Previous studies reported significant variability in adherence to these recommendations. The objective of this study was to evaluate Swiss primary practitioners’ adherence to the GOLD guidelines for the pharmacological treatment of stable COPD. (2) Methods: We studied patients who were included in the Swiss COPD cohort study, an ongoing prospective study in a primary care setting, between 2015 and 2022. The key inclusion criteria are age ≥ 40 years, FEV1/FVC ratio < 70%, and a smoking history of at least 20 pack-years. Adherence to the GOLD guidelines was assessed per visit and over time. (3) Results: The data of 225 COPD patients (mean age 67 ± 9 years, 64% male) and their respective 1163 visits were analyzed. In 65% of visits (726/1121), treatment was prescribed according to the GOLD guidelines. Non-adherence was most common in GOLD groups A and B (64% and 33%) and mainly consisted of over-treatment (two long-acting bronchodilators in group A (98/195, 50%) and ICS in groups A (21/195, 11%) and B (198/808, 25%)). In group D, the prescriptions conformed with the guidelines in 99% of cases (109/108). Guideline adherence was associated with high symptom load (COPD Assessment Test) (OR 1.04, p = 0.002), high number of exacerbations (OR = 2.07, p < 0.001), asthma overlap (OR 3.36, p = 0.049), and diabetes mellitus (OR 2.82, p = 0.045). (4) Conclusion: These results confirm a conflict between the GOLD recommendations and primary practice, mainly concerning over-treatment in GOLD groups A and B. Patients with high symptom load, high exacerbation risk, asthma overlap, and diabetes mellitus are more likely to be treated in conformity with the guidelines. Further research is needed to uncover the reasons for the discrepancies and to design strategies for improvement.

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Does practice follow evidence-based guidelines? Adherence to GOLD guidelines in Portugal

Cited by 5 publications

References 2 publications

Investigating the rationale for COPD maintenance therapy prescription across Europe, findings from a multi-country study

Investigating the rationale for COPD maintenance therapy prescription across Europe, findings from a multi-country study

Investigating the rationale for COPD maintenance therapy prescription across Europe, findings from a multi-country study

Adherence to the GOLD Guidelines in Primary Care: Data from the Swiss COPD Cohort

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