Why are some evidence-based care recommendations in chronic obstructive pulmonary disease better implemented than others? Perspectives of medical practitioners

Abstract

BackgroundClinical guidelines for management of patients with chronic obstructive pulmonary disease (COPD) include recommendations based on high levels of evidence, but gaps exist in their implementation. The aim of this study was to examine the perspectives of medical practitioners regarding implementation of six high-evidence recommendations for the management of people with COPD.MethodsSemi-structured interviews were conducted with medical practitioners involved with care of COPD patients in hospital and general practice. Interviews sought medical practitioners’ experience regarding implementation of smoking cessation, influenza vaccination, pulmonary rehabilitation, guideline-based medications, long-term oxygen therapy for hypoxemia and plan and advice for future exacerbations. Interviews were audiotaped, transcribed verbatim and analyzed using content analysis.ResultsNine hospital-based medical practitioners and seven general practitioners participated. Four major categories were identified which impacted on implementation of the target recommendations in the care of patients with COPD: (1) role clarity of the medical practitioner; (2) persuasive communication with the patient; (3) complexity of behavioral change required; (4) awareness and support available at multiple levels. For some recommendations, strength in all four categories provided significant enablers supporting implementation. However, with regard to pulmonary rehabilitation and plans and advice for future exacerbations, all identified categories that presented barriers to implementation.ConclusionThis study of medical practitioner perspectives has indicated areas where significant barriers to the implementation of key evidence-based recommendations in COPD management persist. Developing strategies to target the identified categories provides an opportunity to achieve greater implementation of those high-evidence recommendations in the care of people with COPD.

Clustering of Unhealthy Lifestyle Behaviors is Associated with a Low Adherence to Recommended Preventive Practices Among COPD Patients in Spain

“…We agree with other authors (10,(23)(24)(25)(26) that the uptake of clinical preventive services among COPD patients included in our study is suboptimal. Between 16-17% of COPD patients did not comply with a blood pressure check-up within the last 6 months.…”

“…Another recent study that explored the views of medical practicioners in hospital and general practice to implementation of several high-evidence care recommendations for patients with COPD identifi ed four main issues that impacted on implementation: clarity of the doctor´s role, use of persuasive communication, nature of the behavior change required and awareness and support strategies available at multiple levels (25). Low implementation of evidence-based care recommendations in COPD patients translates into poorer outcomes for patients, and greater cost to the health care system (30).…”

Intravenous fluid use in the acutely unwell adult medical inpatient: improving practice through a clinical audit process

“…19 New local clinical guidelines therefore need to both create and maintain awareness of the guideline and facilitate compliance. We planned longer-term interventions, hoping to achieve and maintain compliance outside of this audit.…”

Barriers to, and facilitators for, referral to pulmonary rehabilitation in COPD patients from the perspective of Australian general practitioners: a qualitative study

“…smoking cessation, influenza vaccination). 20 However, better communication about local PR service provision and streamlined referral pathways could embed this knowledge in the daily workflow of general practitioners. Harris and co-authors 21 reported similar logistical barriers to PR (referral process and service provision) in focus groups with UK primary care health PRIMARY CARE RESPIRATORY JOURNAL www.thepcrj.org professionals.…”