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Kahle-Wrobleski K, Bui BKH, Friderici J, Moore KJ, Carlyle M, Webb NS, Martin CK, Pace WD, Westfall JM. An Exploratory Study of Physician Decision-Making When Treating Uncontrolled COPD. Int J Chron Obstruct Pulmon Dis 2024; 19:1357-1373. [PMID: 38912054 PMCID: PMC11193463 DOI: 10.2147/copd.s454877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 05/14/2024] [Indexed: 06/25/2024] Open
Abstract
Purpose Current guidelines recommend triple therapy maintenance inhalers for patients with recurrent exacerbations of chronic obstructive pulmonary disease (COPD); however, these maintenance therapies are underutilized. This study aimed to understand how physicians make COPD treatment decisions, and how combination maintenance therapies are utilized in a real-world setting. Patients and Methods This exploratory, hypothesis-generating, non-interventional study used a cross-sectional online survey that was administered to a sample of practicing physicians in the United States. The survey included five fictitious vignettes detailing common symptoms experienced by patients with COPD. Survey questions included factors physicians consider in their decisions, and perceived barriers to prescribing treatments. Repeated measures multivariable analyses were conducted to evaluate how likely physicians were to switch to triple therapy versus no change to patient's current maintenance therapy or change to another maintenance therapy. Results In total, 200 physicians completed the survey. Cost of treatment and patient access to treatment were reported as the most common barriers physicians consider in their prescribing decisions. Physicians were more likely to switch a patient's maintenance inhaler to triple therapy versus no change to maintenance inhaler if they considered the patient's history of new symptoms, insurance status, and clinical guidelines in their decision. Physicians with more experience treating patients with COPD, and those who treat more patients with COPD per week, were more likely to switch to triple therapy versus no change to maintenance inhaler. Conclusion This study demonstrates the complexity of factors that can influence physicians' decisions when prescribing treatments for patients with COPD, including considerations of treatment cost, patient access and adherence, patient comorbidities, efficacy of current treatment, clinical guidelines, and provider's level of experience treating COPD. Further research may help elucidate the relative importance of the factors influencing physicians' decisions and inform what types of decision-support tools would be most beneficial.
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Affiliation(s)
| | - Bonnie K H Bui
- Health Economics and Outcomes Research, Optum Life Sciences, Eden Prairie, MN, USA
| | - Jennifer Friderici
- Health Economics and Outcomes Research, Optum Life Sciences, Eden Prairie, MN, USA
| | - Kristin J Moore
- Health Economics and Outcomes Research, Optum Life Sciences, Eden Prairie, MN, USA
| | - Maureen Carlyle
- Health Economics and Outcomes Research, Optum Life Sciences, Eden Prairie, MN, USA
| | - Noah S Webb
- Health Economics and Outcomes Research, Optum Life Sciences, Eden Prairie, MN, USA
| | - Carolyn K Martin
- Health Economics and Outcomes Research, Optum Life Sciences, Eden Prairie, MN, USA
| | - Wilson D Pace
- DARTNet Institute, Research Department, Aurora, CO, USA
- Family Medicine, University of Colorado Medical School, Denver, CO, USA
| | - John M Westfall
- DARTNet Institute, Research Department, Aurora, CO, USA
- Family Medicine, University of Colorado Medical School, Denver, CO, USA
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2
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Orozco RJ, Rodriguez D, Hunter K, Roy S. The 2021 Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) guidelines and the outpatient management: Examining physician adherence and its effects on patient outcome. J Family Med Prim Care 2024; 13:736-742. [PMID: 38605771 PMCID: PMC11006038 DOI: 10.4103/jfmpc.jfmpc_1397_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/13/2023] [Accepted: 10/03/2023] [Indexed: 04/13/2024] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a common preventable illness that carries a large global economic and social burden. The global initiative for chronic obstructive lung disease (GOLD) guidelines has been utilized as a global strategy for the continued COPD diagnosis, assessment, and treatment. We aimed to determine if the adherence to the 2021 GOLD guideline directed management influenced outcomes. Materials and Methods Retrospective medical records review of adult patients with COPD, who received care in our office during the entire year of 2021. Patients managed as per the 2021 GOLD guidelines were compared with those who received usual care. Results Among 242 patients, 171 (70.7%) were GOLD management adherent (GA) and 71 (29.3%) were GOLD non-adherent (GNA). Certain comorbidities were associated with higher frequencies in the GA group, such as allergic rhinitis (63.2 vs. 18.3%; P < 0.001), coronary artery disease (55.9 vs. 38.0%; P = 0.011), GERD (63.2 vs. 32.4%; P < 0.001), anemia (38.6 vs. 19.7%; P = 0.004), malignancy (34.5 vs. 19.7%; P = 0.023), and immunodeficiency (12.3 vs. 1.4%; P = 0.007). There was no significant difference in the mortality between the GA and GNA groups (5.3 vs. 9.9%; P = 0.254). Although the frequency of number of exacerbations was greater in the GA group, the difference in the mean number of exacerbations was not statistically significant (0.39 ± 1.08 vs. 0.39 ± 1.14; P = 0.984). Conclusion We found no significant difference in the patient outcomes, such as number of exacerbations of COPD and mortality, when comparing the 2021 GOLD guideline adherent versus GOLD guideline non-adherent management of COPD.
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Affiliation(s)
- Ricardo J. Orozco
- Department of Medicine, Cooper University Health Care, Camden, New Jersey, USA
| | - David Rodriguez
- Department of Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Krystal Hunter
- Department of Biostatistics, Cooper Research Institute, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Satyajeet Roy
- Department of Medicine, Cooper University Health Care, Camden, New Jersey, USA
- Department of Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, USA
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Willard-Grace R, Hessler D, Huang B, DeVore D, Chirinos C, Wolf J, Low D, Garvey C, Donesky D, Tsao S, Thom DH, Su G. Pulmonary Specialist-Supported Health Coaching Delivered by Lay Personnel Improves Receipt of Quality Care for Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial. J Patient Cent Res Rev 2023; 10:201-209. [PMID: 38046991 PMCID: PMC10688918 DOI: 10.17294/2330-0698.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Purpose Half of people living with chronic obstructive pulmonary disease (COPD) do not receive high-quality, evidenced-based care as described in international guidelines. We conducted secondary data analysis of a previously published study to assess the ability of a model of lay health coaching to improve provision of guideline-based care in a primary care setting. Methods As part of a randomized controlled trial, we recruited English- and Spanish-speaking patients with moderate to severe COPD from primary care clinics serving a low-income, predominantly African American population. Participants were randomized to receive usual care or 9 months of health coaching from primary care personnel informed by a pulmonary specialist practitioner. Outcome measures included prescription of appropriate inhaler therapy, participation in COPD-related education, engagement with specialty care, prescription of smoking cessation medications, and patient ratings of the quality of care. Results Baseline quality measures did not differ between study arms. At 9 months, coached patients were more likely (increase of 9.3% over usual care; P=0.014) to have received guideline-based inhalers compared to those in usual care. Coached patients were more likely to engage with pulmonary specialty care (increase of 8.3% over usual care with at least 1 visit; P=0.04) and educational classes (increase of 5.3% over usual care; P=0.03). Receipt of smoking cessation medications among patients smoking at baseline in the health coaching group increased 21.1 percentage points more than in usual care, a difference near statistical significance (P=0.06). Conclusions Health coaching may improve the provision of quality chronic illness care for conditions such as COPD.
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Affiliation(s)
- Rachel Willard-Grace
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA
| | - Danielle Hessler
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA
| | - Beatrice Huang
- Division of HIV, Infectious Disease and Global Medicine, University of California, San Francisco, San Francisco, CA
| | - Denise DeVore
- Division of Hematology, Department of Medicine, Stanford University, Stanford, CA
| | | | | | - Devon Low
- independent consultant
- patient research partner
| | | | - DorAnne Donesky
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA
| | - Stephanie Tsao
- San Francisco Department of Public Health, San Francisco, CA
| | - David H. Thom
- Primary Care and Population Health, Stanford University, Stanford, CA
| | - George Su
- Division of Pulmonology, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, San Francisco, CA
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Canadian Health Care Professionals' Familiarity with Chronic Cough Guidelines and Experiences with Diagnosis and Management: A Cross-Sectional Survey. Lung 2023; 201:47-55. [PMID: 36808540 DOI: 10.1007/s00408-023-00604-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 02/01/2023] [Indexed: 02/21/2023]
Abstract
INTRODUCTION Educational programs on chronic cough may improve patient care, but little is known about how Canadian physicians manage this common debilitating condition. We aimed to investigate Canadian physicians' perceptions, attitudes, and knowledge of chronic cough. METHODS We administered a 10-min anonymous, online, cross-sectional survey to 3321 Canadian physicians in the Leger Opinion Panel who managed adult patients with chronic cough and had been in practice for > 2 years. RESULTS Between July 30 and September 22, 2021, 179 physicians (101 general practitioners [GPs] and 78 specialists [25 allergists, 28 respirologists, and 25 ear/nose/throat specialists]) completed the survey (response rate: 5.4%). In a month, GPs saw a mean of 27 patients with chronic cough, whereas specialists saw 46. About one-third of physicians appropriately identified a duration of > 8 weeks as the definition for chronic cough. Many physicians reported not using international chronic cough management guidelines. Patient referrals and care pathways varied considerably, and patients frequently experienced lost to follow-up. While physicians endorsed nasal and inhaled corticosteroids as common treatments for chronic cough, they rarely used other guideline-recommended treatments. Both GPs and specialists expressed high interest in education on chronic cough. CONCLUSION This survey of Canadian physicians demonstrates low uptake of recent advances in chronic cough diagnosis, disease categorization, and pharmacologic management. Canadian physicians also report unfamiliarity with guideline-recommended therapies, including centrally acting neuromodulators for refractory or unexplained chronic cough. This data highlights the need for educational programs and collaborative care models on chronic cough in primary and specialist care.
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Issac H, Keijzers G, Yang IA, Lea J, Taylor M, Moloney C. Development of an Electronic Interdisciplinary Chronic Obstructive Pulmonary Disease (COPD) Proforma (E-ICP) to Improve Interdisciplinary Guideline Adherence in the Emergency Department: Modified Delphi Study. Int J Chron Obstruct Pulmon Dis 2022; 17:1089-1106. [PMID: 35573657 PMCID: PMC9091474 DOI: 10.2147/copd.s358254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/11/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Hancy Issac
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, QLD, Australia
- Centre of Health Research, University of Southern Queensland, Toowoomba, QLD, Australia
- Correspondence: Hancy Issac, School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, QLD, Australia, Email
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, QLD, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
- School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Ian A Yang
- Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Jackie Lea
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, QLD, Australia
- Centre of Health Research, University of Southern Queensland, Toowoomba, QLD, Australia
| | - Melissa Taylor
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, QLD, Australia
- Centre of Health Research, University of Southern Queensland, Toowoomba, QLD, Australia
| | - Clint Moloney
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, QLD, Australia
- College of Health and Biomedicine, Nursing and Midwifery, Victoria University, Melbourne, VIC, Australia
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
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Vachon B, Giasson G, Gaboury I, Gaid D, Noël De Tilly V, Houle L, Bourbeau J, Pomey MP. Challenges and Strategies for Improving COPD Primary Care Services in Quebec: Results of the Experience of the COMPAS+ Quality Improvement Collaborative. Int J Chron Obstruct Pulmon Dis 2022; 17:259-272. [PMID: 35140460 PMCID: PMC8819163 DOI: 10.2147/copd.s341905] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/17/2022] [Indexed: 01/09/2023] Open
Abstract
Introduction Management of chronic obstructive pulmonary disease (COPD) remains a challenge in primary care and multiple barriers can limit implementation of COPD guidelines. Since 2016, a quality improvement (QI) collaborative, called COMPAS+, has been implemented across the province of Quebec (Canada) to support improvement of chronic disease management in primary care. The aim of this study was to describe the main COPD quality problems reported by participating teams and the strategies they proposed and implemented to improve COPD primary care services in Quebec. Methods Sixteen sites in four different regions of Quebec were engaged in the COMPAS+ intervention to improve primary care services delivered to people living with COPD. A total of 14 workshop reports, 31 QI action plans and 4 regional final reports underwent content analysis. Key COPD quality problems were first identified and, for each of them, root causes were classified according to the domains and constructs of the Consolidated Framework for Implementation Research. Proposed strategies were organized according to the intervention function types described in the Behavior Change Wheel. Results Four key COPD quality problems were identified: 1) lack of organization/coordination of COPD services, 2) lack of screening services coordination, 3) lack of interprofessional communication and collaboration and 4) lack of treatment adherence. Main root causes explaining these quality gaps were 1) lack of awareness of COPD, 2) lack of professional knowledge, 3) lack of definition of professional roles, 4) lack of resources and tools for COPD prevention, diagnosis, and follow-up, 5) lack of communication tools, 6) lack of integration of the patient-as-partner approach, and 7) lack of adaptation of patient education to their specific needs. Multiple strategies were proposed to improve healthcare professionals’ education and interprofessional collaboration and communication. Conclusion QI collaborative activities can support achieving understanding of QI challenges healthcare organizations face to improve COPD services.
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Affiliation(s)
- Brigitte Vachon
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche du CIUSSS de l’Est de Montréal, Montreal, Quebec, Canada
- Correspondence: Brigitte Vachon, School of Rehabilitation, Faculty of Medicine, Université de Montréal, CP 6128 Succursale Centre-Ville, Montreal, Quebec, H3C 3J7, Canada, Tel +1 514 343-2094, Email
| | | | - Isabelle Gaboury
- Centre de recherche Charles-Le Moyne, Longueuil, Quebec, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Dina Gaid
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | | | - Lise Houle
- Institut national d’excellence en santé et en services sociaux (INESSS), Montreal, Quebec, Canada
| | - Jean Bourbeau
- Center of Innovative Medicine, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Marie-Pascale Pomey
- Public Health School, Department of Management, Evaluation and Health Policy, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche de Centre hospitalier universitaire de l’Université de Montréal, Montreal, Quebec, Canada
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7
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Issac H, Moloney C, Taylor M, Lea J. Mapping of Modifiable Factors with Interdisciplinary Chronic Obstructive Pulmonary Disease (COPD) Guidelines Adherence to the Theoretical Domains Framework: A Systematic Review. J Multidiscip Healthc 2022; 15:47-79. [PMID: 35046662 PMCID: PMC8759995 DOI: 10.2147/jmdh.s343277] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/16/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND COPD guidelines non-concordance is a challenge frequently highlighted by respiratory experts. Despite the provision of comprehensive evidence-based national and international guidelines, the COPD burden to frontline healthcare services has increased in the last decade. Suboptimal guidelines concordance can be disruptive to health-related quality of life (HRQoL), hastening pulmonary function decline and surging overall morbidity and mortality. A lack of concordance with guidelines has created an escalating economic burden on health-care systems. Identifying interdisciplinary interventions to facilitate improved adherence to guidelines may significantly reduce re-admissions, enhance HRQoL amongst patients and their families, and facilitate economic efficiency. MATERIALS AND METHODS This review adhered to the Joanna Briggs Institute (JBI) methodology for mixed methods systematic reviews and the PRISMA ScR reporting guidelines. Two independent reviewers screened abstracts and full text articles in consonance with inclusion criteria. The convergent integrative JBI method collated quantitative, qualitative and mixed methods studies from nine databases. JBI critical appraisal tools were utilised to assess the quality of research papers. The theoretical domains framework (TDF) along with a specifically developed COPD data extraction tool were adopted as a priori to collect and collate data. Identified barriers and corresponding clinical behavioural change solutions were categorised using TDF domains and behavior change wheel (BCW) to provide future research and implementation recommendations. RESULTS Searches returned 1068 studies from which 37 studies were included (see Figure 1). COPD recommendations identified to be discordant with clinical practice included initiating non-invasive ventilation, over- or under-prescription of corticosteroids and antibiotics, and a lack of discharging patients with a smoking cessation plan or pulmonary rehabilitation. TDF domains with highest frequency scores were knowledge, environmental resources, and clinical behaviour regulation. Electronic order sets/digital proforma with guideline resources at point of care and easily accessible digital community referrals to target both pharmacological and non-pharmacological management appear to be a solution to improve concordance. CONCLUSION Implementation of consistent quality improvement intervention within hospitals for patients with COPD may exclude any implementation gap and prevent readmissions. Electronic proformas with digital referrals will assist with future evaluation audits to prioritise and target interventions to improve guidelines concordance. ETHICS AND DISSEMINATION Ethical approval is not required, and results dissemination will occur through peer-reviewed publication. PROSPERO REGISTRATION NUMBER CRD42020156267.
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Affiliation(s)
- Hancy Issac
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, Australia
| | - Clint Moloney
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Australia
- College of Health and Biomedicine, Nursing and Midwifery, Victoria University, Melbourne, Australia
- Clinical Community Health and Wellbeing, Research Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Melissa Taylor
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, Australia
| | - Jackie Lea
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, Australia
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Cheng SL, Li YR, Huang N, Yu CJ, Wang HC, Lin MC, Chiu KC, Hsu WH, Chen CZ, Sheu CC, Perng DW, Lin SH, Yang TM, Lin CB, Kor CT, Lin CH. Effectiveness of Nationwide COPD Pay-for-Performance Program on COPD Exacerbations in Taiwan. Int J Chron Obstruct Pulmon Dis 2021; 16:2869-2881. [PMID: 34703221 PMCID: PMC8539057 DOI: 10.2147/copd.s329454] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/05/2021] [Indexed: 12/17/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. It has also imposed a substantial economic and social burden on the health care system. In Taiwan, a nationwide COPD pay-for-performance (P4P) program was designed to improve the quality of COPD-related care by introducing financial incentives for health care providers and employing a multidisciplinary team to deliver guideline-based, integrated care for patients with COPD, reducing adverse outcomes, especially COPD exacerbation. However, the results of a survey of the effectiveness of the pay-for-performance program in COPD management were inconclusive. To address this knowledge gap, this study evaluated the effectiveness of the COPD P4P program in Taiwan. Methods This retrospective cohort study used data from Taiwan’s National Health Insurance claims database and nationwide COPD P4P enrollment program records from June 2016 to December 2018. Patients with COPD were classified into P4P and non-P4P groups. Patients in the P4P group were matched at a ratio of 1:1 based on age, gender, region, accreditation level, Charlson Comorbidity Index (CCI), and inhaled medication prescription type to create the non-P4P group. A difference-in-difference analysis was used to evaluate the influence of the P4P program on the likelihood of COPD exacerbation, namely COPD-related emergency department (ED) visit, intensive care unit (ICU) admission, or hospitalization. Results The final sample of 14,288 patients comprised 7144 in each of the P4P and non-P4P groups. The prevalence of COPD-related ED visits, ICU admissions, and hospitalizations was higher in the P4P group than in the non-P4P group 1 year before enrollment. After enrollment, the P4P group exhibited a greater decrease in the prevalence of COPD-related ED visits and hospitalizations than the non-P4P group (ED visit: −2.98%, p<0.05, 95% confidence interval [CI]: −0.277 to −0.086; hospitalization: −1.62%, p<0.05, 95% CI: −0.232 to −0.020), whereas no significant difference was observed between the groups in terms of the changes in the prevalence of COPD-related ICU admissions. Conclusion The COPD P4P program exerted a positive net effect on reducing the likelihood of COPD exacerbation, namely COPD-related ED visits and hospitalizations. Future studies should examine the long-term cost-effectiveness of the COPD P4P program.
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Affiliation(s)
- Shih-Lung Cheng
- Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, 220, Taiwan.,Department of Chemical Engineering and Materials Science, Yuan Ze University, Zhongli, Taoyuan, 320, Taiwan
| | - Yi-Rong Li
- Changhua Christian Hospital, Thoracic Medicine Research Center, Changhua, 500, Taiwan
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Hao-Chien Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Meng-Chih Lin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, 833, Taiwan
| | - Kuo-Chin Chiu
- Division of Chest, Department of Internal Medicine, Poh-Ai Hospital, Luodong, 265, Taiwan
| | - Wu-Huei Hsu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, 404, Taiwan
| | - Chiung-Zuei Chen
- Division of Pulmonary Medicine, Department of Internal Medicine, National Cheng Kung University, College of Medicine and Hospital, Tainan, 701, Taiwan
| | - Chau-Chyun Sheu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, 807, Taiwan.,Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
| | - Diahn-Warng Perng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, 112, Taiwan
| | - Sheng-Hao Lin
- Department of Internal Medicine, Division of Chest Medicine, Changhua Christian Hospital, Changhua, 500, Taiwan
| | - Tsung-Ming Yang
- Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi Branch, 613, Taiwan
| | - Chih-Bin Lin
- Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 970, Taiwan
| | - Chew-Teng Kor
- Big Data Center, Changhua Christian Hospital, Changhua, Changhua Christian Hospital, Changhua, 500, Taiwan
| | - Ching-Hsiung Lin
- Department of Internal Medicine, Division of Chest Medicine, Changhua Christian Hospital, Changhua, 500, Taiwan.,Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, 402, Taiwan.,Department of Recreation and Holistic Wellness, MingDao University, Changhua, 523, Taiwan
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Taylor A, Lowe DJ, McDowell G, Lua S, Burns S, McGinness P, Carlin CM. Remote-Management of COPD: Evaluating the Implementation of Digital Innovation to Enable Routine Care (RECEIVER): the protocol for a feasibility and service adoption observational cohort study. BMJ Open Respir Res 2021; 8:8/1/e000905. [PMID: 34462271 PMCID: PMC8407208 DOI: 10.1136/bmjresp-2021-000905] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 08/07/2021] [Indexed: 11/14/2022] Open
Abstract
Introduction Reductions in exacerbation and hospitalisations are the outcomes rated as most important by people with chronic obstructive pulmonary disease (COPD). Most COPD management is currently based on a reactive approach, and delays in recognising treatable opportunities underpin COPD care quality gaps. Innovations that empower COPD self-management, facilitate integrated clinical care and support delivery of evidence-based treatment interventions are urgently required. Methods and analysis The Remote-Management of COPD: Evaluating the Implementation of Digital Innovation to Enable Routine Care trial is a prospective observational cohort hybrid implementation and effectiveness study that will explore the adoption of a digital service model for people with ‘high-risk’ COPD and evaluate the feasibility of this approach versus current standards of care. People with COPD, who have had recent severe exacerbation and/or COPD–obstructive sleep apnoea overlap or chronic hypercapnic respiratory failure requiring home non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP), with internet access will be recruited into the study and enrolled into the digital service. Study endpoints will examine participant utilisation, clinical service impact and clinical outcomes compared with historical and contemporary control patient data. The digital infrastructure will also provide a foundation to explore the feasibility of approaches to predict outcomes and exacerbation in people with COPD through machine learning analysis. Ethics and dissemination Ethical approval for this clinical trial has been obtained from the West of Scotland Research Ethics Service. The trial will commence in September 2019 for a duration of 2 years. Results will be presented at local, national and international meetings, as well as submission for publication to peer-reviewed journals. Trial registration number NCT04240353.
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Affiliation(s)
- Anna Taylor
- Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, UK
| | - David J Lowe
- Emergency Medicine, Queen Elizabeth University Hospital, Glasgow, UK
| | - Grace McDowell
- Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, UK
| | - Stephanie Lua
- Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, UK
| | - Shane Burns
- Lenus Digital Health, StormID, Edinburgh, UK
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Effects of (a Combination of) the Beta 2-Adrenoceptor Agonist Indacaterol and the Muscarinic Receptor Antagonist Glycopyrrolate on Intrapulmonary Airway Constriction. Cells 2021; 10:cells10051237. [PMID: 34069899 PMCID: PMC8157597 DOI: 10.3390/cells10051237] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 12/01/2022] Open
Abstract
Expression of bronchodilatory β2-adrenoceptors and bronchoconstrictive muscarinic M3-receptors alter with airway size. In COPD, (a combination of) β2-agonists and muscarinic M3-antagonists (anticholinergics) are used as bronchodilators. We studied whether differential receptor expression in large and small airways affects the response to β2-agonists and anticholinergics in COPD. Bronchoprotection by indacaterol (β2-agonist) and glycopyrrolate (anticholinergic) against methacholine- and EFS-induced constrictions of large and small airways was measured in guinea pig and human lung slices using video-assisted microscopy. In guinea pig lung slices, glycopyrrolate (1, 3 and 10 nM) concentration-dependently protected against methacholine- and EFS-induced constrictions, with no differences between large and small intrapulmonary airways. Indacaterol (0.01, 0.1, 1 and 10 μM) also provided concentration-dependent protection, which was greater in large airways against methacholine and in small airways against EFS. Indacaterol (10 μM) and glycopyrrolate (10 nM) normalized small airway hyperresponsiveness in COPD lung slices. Synergy of low indacaterol (10 nM) and glycopyrrolate (1 nM) concentrations was greater in LPS-challenged guinea pigs (COPD model) compared to saline-challenged controls. In conclusion, glycopyrrolate similarly protects large and small airways, whereas the protective effect of indacaterol in the small, but not the large, airways depends on the contractile stimulus used. Moreover, findings in a guinea pig model indicate that the synergistic bronchoprotective effect of indacaterol and glycopyrrolate is enhanced in COPD.
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11
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Issac H, Taylor M, Moloney C, Lea J. Exploring Factors Contributing to Chronic Obstructive Pulmonary Disease (COPD) Guideline Non-Adherence and Potential Solutions in the Emergency Department: Interdisciplinary Staff Perspective. J Multidiscip Healthc 2021; 14:767-785. [PMID: 33854328 PMCID: PMC8039430 DOI: 10.2147/jmdh.s276702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 02/04/2021] [Indexed: 12/01/2022] Open
Abstract
Purpose Acute exacerbations of chronic obstructive pulmonary disease (COPD) have a significant and prolonged impact on health-related quality of life, patient outcomes, and escalation of pulmonary function decline. COPD-X guidelines published in 2003 subsist to facilitate a shift from the emphasis on pharmacological treatment to a more holistic multi-disciplinary interventions approach. Despite the existing comprehensive recommendations, readmission rates have increased in the last decade. Evidence to date has reported sub-optimal COPD guidelines adherence in emergency departments. This qualitative study explored contributing factors to interdisciplinary staff non-adherence and utilisation of COPD-X guidelines in a major Southern Queensland Emergency Department. Methods Semi-structured qualitative interviews with interdisciplinary staff were conducted in an emergency department. A purposive sample of doctors, nurses, physiotherapists, pharmacist and a social worker were recruited. Interviews were digitally recorded, de-identified and transcribed verbatim. Data analysis followed a coding process against the Theoretical Domains Framework (TDF) to examine implementation barriers and potential solutions. Identified factors affecting non-adherence and underutilisation of guidelines were then mapped to the capability, opportunity, motivation, behaviour model (COM-B) and behaviour change wheel (BCW) to inform future implementation recommendations. Results Prominent barriers influencing the clinical uptake of COPD guidelines were identified using TDF analysis and included knowledge, professional role clarity, clinical behaviour regulation, memory, attention, and decision process, beliefs about departmental capabilities, environmental context and resources. Potential interventions included education, training, staffing, funding and time-efficient digitalised referrals and systems management reminders to prevent COPD readmissions, remissions and improve patient health-related quality of life. Conclusion Implementation strategies such as electronic interdisciplinary COPD proforma that facilitates a multimodal approach with appropriate patient/staff resources and referrals prior to discharge from an ED require further exploration. Greater clarity around which components of the COPD X guidelines must be applied in ED settings needs to stem from future research.
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Affiliation(s)
- Hancy Issac
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Australia
| | - Melissa Taylor
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Australia
| | - Clint Moloney
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Australia
| | - Jackie Lea
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Australia
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12
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Curran RL, Kukhareva PV, Taft T, Weir CR, Reese TJ, Nanjo C, Rodriguez-Loya S, Martin DK, Warner PB, Shields DE, Flynn MC, Boltax JP, Kawamoto K. Integrated displays to improve chronic disease management in ambulatory care: A SMART on FHIR application informed by mixed-methods user testing. J Am Med Inform Assoc 2021; 27:1225-1234. [PMID: 32719880 DOI: 10.1093/jamia/ocaa099] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/29/2020] [Accepted: 05/11/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The study sought to evaluate a novel electronic health record (EHR) add-on application for chronic disease management that uses an integrated display to decrease user cognitive load, improve efficiency, and support clinical decision making. MATERIALS AND METHODS We designed a chronic disease management application using the technology framework known as SMART on FHIR (Substitutable Medical Applications and Reusable Technologies on Fast Healthcare Interoperability Resources). We used mixed methods to obtain user feedback on a prototype to support ambulatory providers managing chronic obstructive pulmonary disease. Each participant managed 2 patient scenarios using the regular EHR with and without access to our prototype in block-randomized order. The primary outcome was the percentage of expert-recommended ideal care tasks completed. Timing, keyboard and mouse use, and participant surveys were also collected. User experiences were captured using a retrospective think-aloud interview analyzed by concept coding. RESULTS With our prototype, the 13 participants completed more recommended care (81% vs 48%; P < .001) and recommended tasks per minute (0.8 vs 0.6; P = .03) over longer sessions (7.0 minutes vs 5.4 minutes; P = .006). Keystrokes per task were lower with the prototype (6 vs 18; P < .001). Qualitative themes elicited included the desire for reliable presentation of information which matches participants' mental models of disease and for intuitive navigation in order to decrease cognitive load. DISCUSSION Participants completed more recommended care by taking more time when using our prototype. Interviews identified a tension between using the inefficient but familiar EHR vs learning to use our novel prototype. Concept coding of user feedback generated actionable insights. CONCLUSIONS Mixed methods can support the design and evaluation of SMART on FHIR EHR add-on applications by enhancing understanding of the user experience.
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Affiliation(s)
- Rebecca L Curran
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Polina V Kukhareva
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Teresa Taft
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Charlene R Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Thomas J Reese
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Claude Nanjo
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | | | - Douglas K Martin
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Phillip B Warner
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - David E Shields
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Michael C Flynn
- Community Physicians Group, University of Utah, Salt Lake City, Utah, USA
| | - Jonathan P Boltax
- Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
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13
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Issac H, Moloney C, Taylor M, Lea J. Mapping of modifiable barriers and facilitators with interdisciplinary chronic obstructive pulmonary disease (COPD) guidelines concordance within hospitals to the Theoretical Domains Framework: a mixed methods systematic review protocol. BMJ Open 2020; 10:e036060. [PMID: 32690740 PMCID: PMC7375635 DOI: 10.1136/bmjopen-2019-036060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Multifarious chronic obstructive pulmonary disease (COPD) guidelines have been published by local, national and global respiratory societies. These guidelines subsume holistic evidence based on recommendations to diagnose, treat, prevent and manage acute exacerbation with COPD. Despite the existing comprehensive recommendations, readmission rates and hospitalisations have increased in the last decade. Evidence to date has reported suboptimal clinical guidelines concordance. Acute exacerbations of COPD (AECOPD) is a common hospital presentation due to varied causes such as infective exacerbations, worsening disease condition, medication non-adherence, lack of education and incomprehensive discharge planning. AECOPD directly and indirectly causes economic burden, disrupts health-related quality of life (HRQol), hasten lung function decline and increases overall morbidity and mortality. COPD being a multimodal chronic disease, consistent interdisciplinary interventions from the time of admission to discharge may reduce readmissions and enhance HRQol among these patients and their families. METHODS AND ANALYSIS This protocol adheres to the Joanna Briggs Institute methodology for mixed methods systematic reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews reporting guidelines. Qualitative, quantitative and mixed methods studies will append this study to explore determinants of COPD guidelines concordance. Comprehensive three-tier search strategies will be used to search nine databases (COCHRANE, EBSCO HOST, MEDLINE, SCIENCE DIRECT, JBI, SCOPUS, WEB OF SCIENCE, WILEY and DARE) in May 2020. Two independent reviewers will screen abstracts and full-text articles in consonance with inclusion criteria. The convergent integrative method narrative review will contribute a deeper understanding of any discrepancies found in the existing evidence. Quality of the studies will be reported and Theoretical Domains Framework (TDF) will be used as a priori to synthesis data. Identified barriers, facilitators and corresponding clinical behavioural change solutions will be categorised using TDF indicators to provide future research and implementation recommendations. ETHICS AND DISSEMINATION Ethical approval is not required and results dissemination will occur through peer-reviewed publication.
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Affiliation(s)
- Hancy Issac
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Clint Moloney
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Melissa Taylor
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Jackie Lea
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Queensland, Australia
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14
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Takala J, Ilmarinen P, Tuomisto LE, Vähätalo I, Niemelä O, Kankaanranta H. Planned primary health care asthma contacts during 12-year follow-up after Finnish National Asthma Programme: focus on spirometry. NPJ Prim Care Respir Med 2020; 30:8. [PMID: 32198357 PMCID: PMC7083866 DOI: 10.1038/s41533-020-0166-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/28/2020] [Indexed: 01/08/2023] Open
Abstract
Primary health care (PHC) providers are at the front line of asthma management. To evaluate how planned asthma follow-up occurred in PHC and whether lung function tests were used, 203 patients were followed for 12 years as part of a real-life asthma cohort Seinäjoki Adult Asthma Study (SAAS). A total of 152 patients had visits in PHC attending on average to four planned contacts during 12-year follow-up corresponding to one visit every third year. National guideline recommends annual visits. Patients with ≥4 contacts seemed to have more difficult asthma and better adherence to inhaled corticosteroid medication. Lung function tests were performed on average in 87.5% of annual planned follow-up contacts. Spirometry was performed in 70%, 71% and 97% of all contacts depending on whether it was a contact to GP, nurse or both. Overall, the frequency of follow-up contacts was insufficient but PHC adherence to lung function testing was excellent.
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Affiliation(s)
- Jaana Takala
- Seinäjoki Health Care Centre, Seinäjoki, Finland.
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
| | - Pinja Ilmarinen
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Leena E Tuomisto
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Iida Vähätalo
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Onni Niemelä
- Department of Laboratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
- Tampere University, Tampere, Finland
| | - Hannu Kankaanranta
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
- Department of Respiratory Medicine, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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15
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Chinai B, Hunter K, Roy S. Outpatient Management of Chronic Obstructive Pulmonary Disease: Physician Adherence to the 2017 Global Initiative for Chronic Obstructive Lung Disease Guidelines and its Effect on Patient Outcomes. J Clin Med Res 2019; 11:556-562. [PMID: 31413767 PMCID: PMC6681860 DOI: 10.14740/jocmr3888] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 06/17/2019] [Indexed: 12/22/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a common and preventable illness that carries significant economic and social burden. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) provides a comprehensive review of the available literature for the diagnosis and management of COPD. Despite being considered the standard of care, adherence to the GOLD guidelines varies among practitioners. In addition, there is yet to be a clear correlation between misalignment with GOLD practicing guidelines and patient outcomes. We studied the outpatient management of COPD, with special attention paid to whether or not adherence to the 2017 GOLD guidelines affected patient outcomes. Methods This retrospective electronic medical record review study observed the outpatient management of patients with COPD, aged 18 year or older, who presented to the suburban primary care office. Patients who received treatment according to the GOLD guidelines were compared with the patients who did not. Categorical data were analyzed as frequencies with percentages. Frequencies were compared using Chi-square and Fisher's exact tests. A P value < 0.05 was used to determine statistical significance. Results A total of 158 patients were included in this study. Thirty-six percent of the patients were treated according to the GOLD guidelines. There was no significant difference in the mortality, exacerbations or hospitalizations between the patients who were treated according to the GOLD guidelines and those who were not. Comparing prescribing practices for those treated according to the GOLD guidelines versus those who were not, a significant difference in management occurred in regards to long acting beta agonist (P < 0.05) and inhaled corticosteroid therapy (P < 0.001). The differences in the use of other pharmacological and nonpharmacological agents were not significant. Conclusions Adherence to the 2017 GOLD guidelines had no statistically significant difference in patient outcomes. GOLD nonadherent patients received long-acting beta agonist and inhaled corticosteroid therapy at a significantly higher frequency compared to GOLD-adherent patients.
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Affiliation(s)
- Brian Chinai
- Department of Internal Medicine, Cooper University Healthcare, Camden, NJ, USA
| | - Krystal Hunter
- Cooper Research Institute, Cooper University Healthcare, Camden, NJ, USA.,Cooper Medical School at Rowan University, Camden, NJ, USA
| | - Satyajeet Roy
- Department of Internal Medicine, Cooper University Healthcare, Camden, NJ, USA.,Cooper Medical School at Rowan University, Camden, NJ, USA
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16
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Ghosh S, Anderson WH, Putcha N, Han MK, Curtis JL, Criner GJ, Dransfield MT, Barr RG, Krishnan JA, Lazarus SC, Cooper CB, Paine R, Peters SP, Hansel NN, Martinez FJ, Drummond MB. Alignment of Inhaled Chronic Obstructive Pulmonary Disease Therapies with Published Strategies. Analysis of the Global Initiative for Chronic Obstructive Lung Disease Recommendations in SPIROMICS. Ann Am Thorac Soc 2019; 16:200-208. [PMID: 30216731 PMCID: PMC6376942 DOI: 10.1513/annalsats.201804-283oc] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 09/12/2018] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Despite awareness of chronic obstructive pulmonary disease (COPD) treatment recommendations, uptake is poor. The Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) spans 2010-2016, providing an opportunity to assess integration of 2011 Global Initiative for Obstructive Lung Disease (GOLD) treatment strategies over time in a large observational cohort study. OBJECTIVES To evaluate how COPD treatment aligns with 2011 GOLD strategies and determine factors associated with failure to align with recommendations. METHODS Information on inhaled medication use collected via questionnaire annually for 4 years was compiled into therapeutic classes (long-acting antimuscarinic agent, long-acting β-agonist, inhaled corticosteroids [ICS], and combinations thereof). Medications were not modified by SPIROMICS investigators. 2011 GOLD COPD categories A, B, C, and D were assigned. Alignment of inhaler regimen with first-/second-line GOLD recommendations was determined, stratifying into recommendation aligned or nonaligned. Recommendation-nonaligned participants were further stratified into overuse and underuse categories. RESULTS Of 1,721 participants with COPD, at baseline, 52% of regimens aligned with GOLD recommendations. Among participants with nonaligned regimens, 46% reported underuse, predominately owing to lack of long-acting inhalers in GOLD category D. Of the 54% reporting overuse, 95% were treated with nonindicated ICS-containing regimens. Among 431 participants with 4 years of follow-up data, recommendation alignment did not change over time. When we compared 2011 and 2017 recommendations, we found that 47% did not align with either set of recommendations, whereas 35% were in alignment with both recommendations. CONCLUSIONS Among SPIROMICS participants with COPD, nearly 50% reported inhaler regimens that did not align with GOLD recommendations. Nonalignment was driven largely by overuse of ICS regimens in milder disease and lack of long-acting inhalers in severe disease.
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Affiliation(s)
- Sohini Ghosh
- 1 Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, and
| | - Wayne H Anderson
- 2 Marsico Lung Institute/Cystic Fibrosis Research Center, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nirupama Putcha
- 3 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Meilan K Han
- 4 Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan Health System, Ann Arbor, Michigan
| | - Jeffrey L Curtis
- 4 Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan Health System, Ann Arbor, Michigan
| | - Gerard J Criner
- 5 Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Mark T Dransfield
- 6 Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - R Graham Barr
- 7 Department of Medicine, Columbia University Medical Center, New York, New York
| | - Jerry A Krishnan
- 8 Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois, Chicago, Illinois
| | - Stephen C Lazarus
- 9 Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Christopher B Cooper
- 10 Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Robert Paine
- 11 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Stephen P Peters
- 12 Department of Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest Baptist Health, Winston Salem, North Carolina; and
| | - Nadia N Hansel
- 3 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Fernando J Martinez
- 13 Department of Medicine, Weill Cornell Medical College, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - M Bradley Drummond
- 1 Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, and
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17
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Niyonsenga T, Coffee NT, Del Fante P, Høj SB, Daniel M. Practical utility of general practice data capture and spatial analysis for understanding COPD and asthma. BMC Health Serv Res 2018; 18:897. [PMID: 30477507 PMCID: PMC6260571 DOI: 10.1186/s12913-018-3714-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/14/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND General practice-based (GP) healthcare data have promise, when systematically collected, to support estimating local rates of chronic obstructive pulmonary disease (COPD) and asthma, variations in burden of disease, risk factors and comorbid conditions, and disease management and quality of care. The use of GP information systems for health improvement has been limited, however, in the scope and quality of data. This study assessed the practical utility of de-identified clinical databases for estimating local rates of COPD and asthma. We compared COPD and asthma rates to national benchmarks, examined health related risk factors and co-morbidities as correlates of COPD and asthma, and assessed spatial patterns in prevalence estimates at the small-area level. METHODS Data were extracted from five GP databases in western Adelaide, South Australia, for active patients residing in the region between 2012 and 2014. Prevalence estimates were computed at the statistical area 1 (SA1) spatial unit level using the empirical Bayes estimation approach. Descriptive analyses included summary statistics, spatial indices and mapping of geographic patterns. Bivariate associations were assessed, and disease profiles investigated to ascertain multi-morbidities. Multilevel logistic regression models were fitted, accounting for individual covariates including the number of comorbid conditions to assess the influence of area-level socio-economic status (SES). RESULTS For 33,725 active patients, prevalence estimates were 3.4% for COPD and 10.3% for asthma, 0.8% higher and 0.5% lower for COPD and asthma, respectively, against 2014-15 National Health Survey (NHS) benchmarks. Age-specific comparisons showed discrepancies for COPD in the '64 years or less' and 'age 65 and up' age groups, and for asthma in the '15-25 years' and '75 years and up' age groups. Analyses confirmed associations with individual-level factors, co-morbid conditions, and area-level SES. Geographic aggregation was seen for COPD and asthma, with clustering around GP clinics and health care centres. Spatial patterns were inversely related to area-level SES. CONCLUSION GP-based data capture and analysis has a clear potential to support research for improved patient outcomes for COPD and asthma via knowledge of geographic variability and its correlates, and how local prevalence estimates differ from NHS benchmarks for vulnerable age-groups.
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Affiliation(s)
- T Niyonsenga
- Centre for Research and Action in Public Health, Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia. .,Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.
| | - N T Coffee
- Centre for Research and Action in Public Health, Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia.,Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - P Del Fante
- Healthfirst Network, Adelaide, South Australia, Australia.,Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - S B Høj
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada.,Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - M Daniel
- Centre for Research and Action in Public Health, Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia.,Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.,Department of Medicine, St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
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18
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Rosińczuk J, Przyszlak M, Uchmanowicz I. Sociodemographic and clinical factors affecting the quality of life of patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2018; 13:2869-2882. [PMID: 30254434 PMCID: PMC6143638 DOI: 10.2147/copd.s165714] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background COPD remains a significant challenge for contemporary medicine. It is one of the most common respiratory illnesses and leads to disability as well as deteriorating patient’s quality of life (QOL). Objective The objective of this study was to determine the impact of selected sociodemographic and clinical factors on QOL and level of illness acceptance (LIA) of patients with COPD. Design This study was a cross-sectional, prospective, observational study. Patients and methods The study involved 100 patients (34 women and 66 men) suffering from COPD for at least half a year, treated in the Allergology Clinic at the Department of Internal Medicine, Geriatrics and Allergy, Wroclaw Medical University in Poland. Standardized questionnaires such as Short Form-36 Health Survey, Saint George’s Respiratory Questionnaire, Acceptance of Illness Scale, and COPD Author’s Questionnaire were used to assess QOL and LIA. Results Among the most significant results, there were no statistically significant differences between the patients’ sex and their QOL and LIA (P>0.05). It has been observed that with an increase in the age of patients, a statistically significant decrease in LIA is observed, especially after 60 years of age (P=0.001). It was found that the higher level of education of the patients was statistically significant in the higher QOL (P<0.05) and in the greater LIA (P<0.05). Interestingly, there was no statistically significant effect of active smoking and overweight on QOL and LIA (P>0.05). Conclusion Sex of COPD patients does not affect their QOL or LIA, nonetheless, the age decreases the level of QOL and LIA. Higher education improves QOL scores; however, factors such as dyspnea, longer duration of illness, comorbidities, oxygen therapy undertaking, and family burden of respiratory disease affect deterioration of QOL.
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Affiliation(s)
- Joanna Rosińczuk
- Department of Nervous System Diseases, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland,
| | - Maria Przyszlak
- Center of Postgraduate Education for Nurses and Midwives, Warsaw, Poland
| | - Izabella Uchmanowicz
- Division of Nursing in Internal Medicine Procedures, Wroclaw Medical University, Wroclaw, Poland
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19
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Huang YC, Ferry OR, McKenzie SC, Bowman RV, Hamilton M, Masel PJ, Fong KM, Yang IA. Diagnosis of the cause of chronic dyspnoea in primary and tertiary care: characterizing diagnostic confidence. J Thorac Dis 2018; 10:3745-3756. [PMID: 30069373 DOI: 10.21037/jtd.2018.05.183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background Chronic dyspnoea (breathlessness) in adults is a common symptom, the exact cause of which may be difficult to diagnose on initial presentation. We characterised the diagnostic complexity of chronic dyspnoea in primary care and tertiary care. Methods This retrospective observational study screened consecutive referral letters of all adult patients referred to cardiology or respiratory clinics at a tertiary referral hospital, during May to June 2015. For patients referred due to chronic dyspnoea, data were analysed from the initial referral letter and subsequent specialist clinic letters for the 6-month time period after referral. Results Of 1,370 patient referrals, 122 patients (mean age 63 y, 55% female) were referred due to chronic dyspnoea. One hundred and five patients (86%) were referred from primary care and 17 (14%) from other hospital clinics. Sixty-one percent were referred with an evident diagnosis (referrer was confident of the initial diagnosis), whereas 39% had non-evident or unclear diagnoses. By 6 months after referral, a definitive final diagnosis had been determined by the specialist clinics in 62% of patients. The majority of patients had been referred appropriately to a cardiology or respiratory clinic, based on the final diagnosis. However, only 26% of diagnoses were fully concordant between the initial referrer diagnosis and the final specialist clinic diagnosis, with 26% being partially concordant and 48% non-concordant. Diagnostic certainty of the referrer was associated with concordance of diagnosis between the referrer and specialist clinic (P<0.001). Conclusions In adult patients referred due to chronic dyspnoea to hospital specialist clinics, there is considerable diagnostic uncertainty about its aetiology, for both referring doctors and specialist clinics. These results demonstrate the current difficulty in diagnosing the cause of chronic dyspnoea in adults, and highlight the need for evidence-based diagnostic pathways.
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Affiliation(s)
- Yao C Huang
- Thoracic Medicine Program, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Queensland, Australia
| | - Olivia R Ferry
- Thoracic Medicine Program, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Queensland, Australia
| | - Scott C McKenzie
- Faculty of Medicine, The University of Queensland, Queensland, Australia.,Cardiology Program, The Prince Charles Hospital, Metro North Hospital and Health Service, Queensland, Australia
| | - Rayleen V Bowman
- Thoracic Medicine Program, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Queensland, Australia
| | | | - Philip J Masel
- Thoracic Medicine Program, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Queensland, Australia
| | - Kwun M Fong
- Thoracic Medicine Program, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Queensland, Australia
| | - Ian A Yang
- Thoracic Medicine Program, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Queensland, Australia
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20
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Miravitlles M, Roche N, Cardoso J, Halpin D, Aisanov Z, Kankaanranta H, Kobližek V, Śliwiński P, Bjermer L, Tamm M, Blasi F, Vogelmeier CF. Chronic obstructive pulmonary disease guidelines in Europe: a look into the future. Respir Res 2018; 19:11. [PMID: 29347928 PMCID: PMC5774162 DOI: 10.1186/s12931-018-0715-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 01/05/2018] [Indexed: 02/07/2023] Open
Abstract
Clinical practice guidelines are ubiquitous and are developed to provide recommendations for the management of many diseases, including chronic obstructive pulmonary disease. The development of these guidelines is burdensome, demanding a significant investment of time and money. In Europe, the majority of countries develop their own national guidelines, despite the potential for overlap or duplication of effort. A concerted effort and consolidation of resources between countries may alleviate the resource-intensity of maintaining individual national guidelines. Despite significant resource investment into the development and maintenance of clinical practice guidelines, their implementation is suboptimal. Effective strategies of guideline dissemination must be given more consideration, to ensure adequate implementation and improved patient care management in the future.
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Affiliation(s)
- Marc Miravitlles
- Pneumology Department, University Hospital Vall d'Hebron, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
| | - Nicolas Roche
- Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital Cochin (AP-HP), University Paris Descartes (EA2511), Paris, France
| | - João Cardoso
- Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | - Zaurbek Aisanov
- Pulmonology Department, Pulmonology Research Institute, Russian National Medical University, Moscow, Russia
| | - Hannu Kankaanranta
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Vladimir Kobližek
- Department of Pneumology, University Hospital Hradec Kralove, Faculty of Medicine in Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
| | - Paweł Śliwiński
- 2nd Department of Respiratory Medicine, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Leif Bjermer
- Department of Respiratory Medicine & Allergology, Skåne University Hospital, Lund, Sweden
| | - Michael Tamm
- Clinic of Pulmonary Medicine and Respiratory Cell Research, University Hospital, Basel, Switzerland
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, and Department of Internal Medicine, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany
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21
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Alsubaiei ME, Cafarella PA, Frith PA, McEvoy RD, Effing TW. Factors influencing management of chronic respiratory diseases in general and chronic obstructive pulmonary disease in particular in Saudi Arabia: An overview. Ann Thorac Med 2018; 13:144-149. [PMID: 30123332 PMCID: PMC6073786 DOI: 10.4103/atm.atm_293_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The prevalence of chronic obstructive pulmonary disease in Saudi Arabia is
4.2% among the general population and 14.2% among smokers. Studies
showed that management of respiratory diseases is inadequate. In this article,
we have elaborated on how factors as health economic factors, lack of
health-care providers, culture, attitude, lifestyle (such as smoking and
physical inactivity), and lack of adherence to the evidence-based practice
guidelines may influence chronic respiratory disease management in Saudi Arabia.
We have to conclude that these factors should be taken into account while
seeking to improve and optimize the quality of care for patients with
respiratory diseases in Saudi Arabia.
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Affiliation(s)
- Mohammed E Alsubaiei
- Department of Respiratory Medicine, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia.,School of Medicine, Flinders University, Adelaide, South Australia, Australia.,Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Paul A Cafarella
- Department of Respiratory Medicine, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia.,School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Peter A Frith
- Department of Respiratory Medicine, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia.,School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - R Doug McEvoy
- School of Medicine, Flinders University, Adelaide, South Australia, Australia.,Department of Sleep and Respiratory Medicine, Adelaide Institute for Sleep Health, Southern Adelaide Local Health Network, School of Medicine, Flinders University, Adelaide, Australia
| | - Tanja W Effing
- Department of Respiratory Medicine, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia.,School of Medicine, Flinders University, Adelaide, South Australia, Australia
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22
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Chan KP, Ko FWS, Chan HS, Wong ML, Mok TYW, Choo KL, Hui DSC. Adherence to a COPD treatment guideline among patients in Hong Kong. Int J Chron Obstruct Pulmon Dis 2017; 12:3371-3379. [PMID: 29238182 PMCID: PMC5713700 DOI: 10.2147/copd.s147070] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This study aimed to assess the adherence rate of pharmacological treatment to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline published in 2011 and the prevalence of comorbidities among patients with COPD in Hong Kong (HK). METHODS Patients were recruited from five tertiary respiratory centers and followed up for 12 months. Data on baseline physiological, spirometric parameters, use of COPD medications and coexisting comorbidities were collected. The relationship between guideline adherence rate and subsequent COPD exacerbations was assessed. RESULTS Altogether, 450 patients were recruited. The mean age was 73.7±8.5 years, and 92.2% of them were males. Approximately 95% of them were ever-smokers, and the mean post-bronchodilator (BD) forced expiratory volume in 1 second was 50.8%±21.7% predicted. The mean COPD Assessment Test and modified Medical Research Council Dyspnea Scale were 13.2±8.1 and 2.1±1.0, respectively. In all, five (1.1%), 164 (36.4%), eight (1.8%) and 273 (60.7%) patients belonged to COPD groups A, B, C and D, respectively. The guideline adherence rate for pharmacological treatment ranged from 47.7% to 58.1% in the three clinic visits over 12 months, with overprescription of inhaled corticosteroids (ICS) and underutilization of long-acting BDs in group B COPD patients. Guideline nonadherence was not associated with increased risk of exacerbation after adjustment of confounding variables. However, this study was not powered to assess a difference in exacerbations. In all, 80.9% of patients had at least one comorbidity. CONCLUSION A suboptimal adherence to GOLD guideline 2011, with overprescription of ICS, was identified. The commonly found comorbidities also aligned with the trend observed in other observational cohorts.
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Affiliation(s)
- Ka Pang Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital
| | - Fanny WS Ko
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital
| | - Hok Sum Chan
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital
| | - Mo Lin Wong
- Department of Medicine and Geriatrics, Caritas Medical Centre
| | | | - Kah Lin Choo
- Department of Medicine, North District Hospital, Hong Kong
| | - David SC Hui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital
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23
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Sehl J, O'Doherty J, O'Connor R, O'Sullivan B, O'Regan A. Adherence to COPD management guidelines in general practice? A review of the literature. Ir J Med Sci 2017; 187:403-407. [PMID: 28735500 DOI: 10.1007/s11845-017-1651-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 06/19/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a progressive illness that is mostly managed in the general practice setting. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines are the international gold standard, and it is important to understand how these are being applied in general practice. AIMS This review aimed to assess the current level of adherence to international best practice guidelines among general practitioners in relation to COPD. METHODS PubMed and EMBASE searches (from 2012 to 2016) were performed and used the search terms guidelines, COPD, general practitioners, and primary care. Papers were excluded if they were not primary sources, were published before 2012, or did not pertain to a general practice setting. RESULTS After applying set inclusion and exclusion criteria, 11 studies were retrieved. These papers were grouped under three categories: diagnosis, pharmacological, and non-pharmacological management, based on the GOLD guidelines. CONCLUSIONS Current studies show significant variability in adherence to the GOLD guidelines. Barriers identified include lack of clarity, unfamiliarity with recommendations, and lack of familiarity with the guidelines. If general practice is expected to manage COPD and other chronic diseases, health service investment is needed to provide appropriate focused guidelines, to support their dissemination and resources to implement them in practice.
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Affiliation(s)
- J Sehl
- University of Limerick Graduate Entry Medical School, Limerick, Ireland.
| | - J O'Doherty
- University of Limerick Graduate Entry Medical School, Limerick, Ireland
| | - R O'Connor
- University of Limerick Graduate Entry Medical School, Limerick, Ireland
| | | | - A O'Regan
- University of Limerick Graduate Entry Medical School, Limerick, Ireland
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24
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Basheti IA, Obeidat NM, Reddel HK. Effect of novel inhaler technique reminder labels on the retention of inhaler technique skills in asthma: a single-blind randomized controlled trial. NPJ Prim Care Respir Med 2017; 27:9. [PMID: 28184045 PMCID: PMC5434787 DOI: 10.1038/s41533-017-0011-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 11/25/2016] [Accepted: 12/09/2016] [Indexed: 11/09/2022] Open
Abstract
Inhaler technique can be corrected with training, but skills drop off quickly without repeated training. The aim of our study was to explore the effect of novel inhaler technique labels on the retention of correct inhaler technique. In this single-blind randomized parallel-group active-controlled study, clinical pharmacists enrolled asthma patients using controller medication by Accuhaler [Diskus] or Turbuhaler. Inhaler technique was assessed using published checklists (score 0-9). Symptom control was assessed by asthma control test. Patients were randomized into active (ACCa; THa) and control (ACCc; THc) groups. All patients received a "Show-and-Tell" inhaler technique counseling service. Active patients also received inhaler labels highlighting their initial errors. Baseline data were available for 95 patients, 68% females, mean age 44.9 (SD 15.2) years. Mean inhaler scores were ACCa:5.3 ± 1.0; THa:4.7 ± 0.9, ACCc:5.5 ± 1.1; THc:4.2 ± 1.0. Asthma was poorly controlled (mean ACT scores ACCa:13.9 ± 4.3; THa:12.1 ± 3.9; ACCc:12.7 ± 3.3; THc:14.3 ± 3.7). After training, all patients had correct technique (score 9/9). After 3 months, there was significantly less decline in inhaler technique scores for active than control groups (mean difference: Accuhaler -1.04 (95% confidence interval -1.92, -0.16, P = 0.022); Turbuhaler -1.61 (-2.63, -0.59, P = 0.003). Symptom control improved significantly, with no significant difference between active and control patients, but active patients used less reliever medication (active 2.19 (SD 1.78) vs. control 3.42 (1.83) puffs/day, P = 0.002). After inhaler training, novel inhaler technique labels improve retention of correct inhaler technique skills with dry powder inhalers. Inhaler technique labels represent a simple, scalable intervention that has the potential to extend the benefit of inhaler training on asthma outcomes. ASTHMA REMINDER LABELS IMPROVE INHALER TECHNIQUE: Personalized labels on asthma inhalers remind patients of correct technique and help improve symptoms over time. Iman Basheti at the Applied Science Private University in Jordan and co-workers trialed the approach of placing patient-specific reminder labels on dry-powder asthma inhalers to improve long-term technique. Poor asthma control is often exacerbated by patients making mistakes when using their inhalers. During the trial, 95 patients received inhaler training before being split into two groups: the control group received no further help, while the other group received individualized labels on their inhalers reminding them of their initial errors. After three months, 67% of patients with reminder labels retained correct technique compared to only 12% of controls. They also required less reliever medication and reported improved symptoms. This represents a simple, cheap way of tackling inhaler technique errors.
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Affiliation(s)
- Iman A Basheti
- Department of Clinical Pharmacy & Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan.
| | - Nathir M Obeidat
- Department of Internal Medicine, Faculty of Medicine, University of Jordan, Respiratory and sleep Medicine, Jordan University Hospital, Amman, Jordan
| | - Helen K Reddel
- Woolcock Institute of Medical Research, University of Sydney, Camperdown, NSW, Australia
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25
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Duenk RG, Verhagen C, Dekhuijzen P, Vissers K, Engels Y, Heijdra Y. The view of pulmonologists on palliative care for patients with COPD: a survey study. Int J Chron Obstruct Pulmon Dis 2017; 12:299-311. [PMID: 28176900 PMCID: PMC5261600 DOI: 10.2147/copd.s121294] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Introduction Early palliative care is not a common practice for patients with COPD. Important barriers are the identification of patients for palliative care and the organization of such care in this patient group. Objective Pulmonologists have a central role in providing good quality palliative care for patients with COPD. To guide future research and develop services, their view on palliative care for these patients was explored. Methods A survey study was performed by the members of the Netherlands Association of Physicians for Lung Diseases and Tuberculosis. Results The 256 respondents (31.8%) covered 85.9% of the hospital organizations in the Netherlands. Most pulmonologists (92.2%) indicated to distinguish a palliative phase in the COPD trajectory, but there was no consensus about the different criteria used for its identification. Aspects of palliative care in COPD considered important were advance care planning conversation (82%), communication between pulmonologist and general practitioner (77%), and identification of the palliative phase (75.8%), while the latter was considered the most important aspect for improvement (67.6%). Pulmonologists indicated to prefer organizing palliative care for hospitalized patients with COPD themselves (55.5%), while 30.9% indicated to prefer cooperation with a specialized palliative care team (SPCT). In the ambulatory setting, a multidisciplinary cooperation between pulmonologist, general practitioner, and a respiratory nurse specialist was preferred (71.1%). Conclusion To encourage pulmonologists to timely initiate palliative care in COPD, we recommend to conduct further research into more specific identification criteria. Furthermore, pulmonologists should improve their skills of palliative care, and the members of the SPCT should be better informed about the management of COPD to improve care during hospitalization. Communication between pulmonologist and general practitioner should be emphasized in training to improve palliative care in the ambulatory setting.
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Affiliation(s)
- R G Duenk
- Department of Anesthesiology, Pain and Palliative Medicine
| | - C Verhagen
- Department of Anesthesiology, Pain and Palliative Medicine
| | - Pnr Dekhuijzen
- Department of Lung Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Kcp Vissers
- Department of Anesthesiology, Pain and Palliative Medicine
| | - Y Engels
- Department of Anesthesiology, Pain and Palliative Medicine
| | - Y Heijdra
- Department of Lung Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
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26
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Morsø L, Jensen MS, von Plessen C, Qvist P. Rehabilitation of Discharged Patients With Chronic Obstructive Pulmonary Disease-Are New Strategies Needed? Health Serv Res Manag Epidemiol 2017; 4:2333392816687704. [PMID: 28508012 PMCID: PMC5415270 DOI: 10.1177/2333392816687704] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 09/12/2016] [Indexed: 11/17/2022] Open
Abstract
Background: Rehabilitation after hospital stay implies several benefits for patients with chronic obstructive pulmonary disease (COPD); still few patients are referred and participate in rehabilitation programs. We conducted a case study to investigate the effects of interventions targeting the referral, uptake, and completion for a program of early rehabilitation in the primary health-care sector. Methods: We undertook targeted initiatives to make patients participate in an individualized rehabilitation program with gradual increased intensity. After discharge, primary care COPD nurses and physiotherapists guided patients through progressing exercises in small groups online. Patients proceeded to class-based exercises, patient education and/or leisure activities, or continued telerehabilitation. We evaluated the effects of the intervention by assessing referral rates, completion, and readmission. Results: Sixteen (23% of discharged patients) patients were referred to rehabilitation. In comparison, only 1 (0.8%) in 131 patients from Vejle hospital was referred to Vejle hospital. Twelve patients completed rehabilitation, all having severe COPD. All started the program within 2 weeks and proceeded to the online-guided exercises within 4 weeks. Study data showed that after 30 days, 1 (6.3%) of the 16 patients in the rehabilitation program had been readmitted compared to 8 (14.8%) of 55 patients who were not referred. After 90 days, 2 (12.5%) and 11 (20.0%) patients were readmitted, respectively. The readmission rate showed a nonsignificant decline in patients participating in rehabilitation. Conclusion: This case study showed that the referral rate of patients with COPD to early municipal rehabilitation is extremely low without a targeted effort and still insufficient in spite of a focused intervention. We showed that completion of a municipal rehabilitation program shortly after discharge is possible even for patients with severe COPD. The findings from our pilot study can guide further investigations into the effect of implementation strategies for handovers between health-care sectors to secure early-onset rehabilitation of patients with COPD.
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Affiliation(s)
- Lars Morsø
- Department for Regional Health Research, Centre for Quality, University of Southern Denmark, Odense, Denmark
| | - Morten Sall Jensen
- Department for Regional Health Research, Centre for Quality, University of Southern Denmark, Odense, Denmark
| | - Christian von Plessen
- Department for Regional Health Research, Centre for Quality, University of Southern Denmark, Odense, Denmark
| | - Peter Qvist
- Department for Regional Health Research, Centre for Quality, University of Southern Denmark, Odense, Denmark
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27
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Willard KS, Sullivan JB, Thomashow BM, Jones CS, Fromer L, Yawn BP, Amin A, Rommes JM, Rotert R. The 2nd National COPD Readmissions Summit and Beyond: From Theory to Implementation. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2016; 3:778-790. [PMID: 28848903 DOI: 10.15326/jcopdf.3.4.2016.0162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) hospitalizations and readmissions adversely impact the health and quality of life of COPD patients. Under the Hospital Readmissions Reduction Program, the Centers for Medicare & Medicaid Services reduce payments to those hospitals exceeding expected rates of COPD readmissions within 30 days of hospital discharge. It was within this climate that the COPD Foundation held its 2nd COPD Readmissions Summit in March 2015. Experts in attendance: (1) categorized challenges to optimal COPD care, ( 2) analyzed the state of care delivery and readmissions reduction strategies and (3) identified the best available evidence-based approaches to improving care delivery across the continuum, including early diagnosis via spirometry, ongoing device, oxygen and medication reconciliation, treatment that addresses comorbidities and preventive care, robust patient education, prompt post-acute follow up, home health services and pulmonary rehabilitation. Results of this collaborative event formed the basis for PRAXIS, the COPD Foundation's initiative to improve COPD care across the health continuum and to reduce readmissions.
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Affiliation(s)
| | | | - Byron M Thomashow
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Catherine S Jones
- American Association of Nurse Practitioners and Texas Woman's University, Dallas
| | - Leonard Fromer
- University of California-Los Angeles, School of Medicine, Los Angeles
| | - Barbara P Yawn
- Department of Family and Community Health, University of Minnesota, Blaine
| | - Alpesh Amin
- Department of Medicine, University of California, Irvine
| | - Jean M Rommes
- Emphysema Foundation for Our Rights to Survive (EFFORTS), Kansas City, Missouri
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28
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Bryant J, Mansfield E, Boyes AW, Waller A, Sanson-Fisher R, Regan T. Involvement of informal caregivers in supporting patients with COPD: a review of intervention studies. Int J Chron Obstruct Pulmon Dis 2016; 11:1587-96. [PMID: 27478372 PMCID: PMC4951056 DOI: 10.2147/copd.s107571] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Caregivers of individuals with COPD have a key role in maintaining patient adherence and optimizing patient function. However, no systematic review has examined how the caregiver role has been operationalized in interventions to improve outcomes of individuals with COPD or the quality or effectiveness of these interventions. The aims of this review were to 1) determine whether caregivers have been involved as part of interventions to improve outcomes of individuals with COPD; 2) determine the risk of bias within included intervention studies; and 3) examine the effectiveness of interventions that have involved caregivers in improving outcomes of individuals with COPD. The electronic databases of Medline, Embase, PsycINFO, and Cochrane Library were searched from January 2000 to November 2015. Experimental studies testing interventions that involved a caregiver to improve COPD patient outcomes were eligible. Nine studies involving caregivers met inclusion criteria. No studies reported any intervention components targeted solely at caregivers, with most instead including caregivers in dyadic or group education sessions about COPD delivered by health care professionals. The risk of bias identified in included studies was mixed. Seven of the nine studies were effective in improving a broad range of outcomes. These findings highlight that there is an urgent need for methodologically rigorous interventions to examine the effectiveness of strategies to assist caregivers to provide direct care, encourage adherence to health care provider recommendations, act as a health care advocate, and provide emotional and psychosocial support to individuals with COPD.
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Affiliation(s)
- Jamie Bryant
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour; Hunter Medical Research Institute, University of Newcastle, Callaghan, NSW, Australia
| | - Elise Mansfield
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour; Hunter Medical Research Institute, University of Newcastle, Callaghan, NSW, Australia
| | - Allison W Boyes
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour; Hunter Medical Research Institute, University of Newcastle, Callaghan, NSW, Australia
| | - Amy Waller
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour; Hunter Medical Research Institute, University of Newcastle, Callaghan, NSW, Australia
| | - Rob Sanson-Fisher
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour; Hunter Medical Research Institute, University of Newcastle, Callaghan, NSW, Australia
| | - Timothy Regan
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour; Hunter Medical Research Institute, University of Newcastle, Callaghan, NSW, Australia
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29
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López-Campos JL, Abad Arranz M, Calero Acuña C, Romero Valero F, Ayerbe García R, Hidalgo Molina A, Aguilar Perez-Grovas RI, García Gil F, Casas Maldonado F, Caballero Ballesteros L, Sánchez Palop M, Pérez-Tejero D, Segado A, Calvo Bonachera J, Hernández Sierra B, Doménech A, Arroyo Varela M, González Vargas F, Cruz Rueda JJ. Determinants for changing the treatment of COPD: a regression analysis from a clinical audit. Int J Chron Obstruct Pulmon Dis 2016; 11:1171-8. [PMID: 27330285 PMCID: PMC4898035 DOI: 10.2147/copd.s103614] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Introduction This study is an analysis of a pilot COPD clinical audit that evaluated adherence to guidelines for patients with COPD in a stable disease phase during a routine visit in specialized secondary care outpatient clinics in order to identify the variables associated with the decision to step-up or step-down pharmacological treatment. Methods This study was a pilot clinical audit performed at hospital outpatient respiratory clinics in the region of Andalusia, Spain (eight provinces with over eight million inhabitants), in which 20% of centers in the area (catchment population 3,143,086 inhabitants) were invited to participate. Treatment changes were evaluated in terms of the number of prescribed medications and were classified as step-up, step-down, or no change. Three backward stepwise binominal multivariate logistic regression analyses were conducted to evaluate variables associated with stepping up, stepping down, and inhaled corticosteroids discontinuation. Results The present analysis evaluated 565 clinical records (91%) of the complete audit. Of those records, 366 (64.8%) cases saw no change in pharmacological treatment, while 99 patients (17.5%) had an increase in the number of drugs, 55 (9.7%) had a decrease in the number of drugs, and 45 (8.0%) noted a change to other medication for a similar therapeutic scheme. Exacerbations were the main factor in stepping up treatment, as were the symptoms themselves. In contrast, rather than symptoms, doctors used forced expiratory volume in 1 second and previous treatment with long-term antibiotics or inhaled corticosteroids as the key determinants to stepping down treatment. Conclusion The majority of doctors did not change the prescription. When changes were made, a number of related factors were noted. Future trials must evaluate whether these therapeutic changes impact clinically relevant outcomes at follow-up.
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Affiliation(s)
- Jose Luis López-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - María Abad Arranz
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain
| | - Carmen Calero Acuña
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
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30
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Ko FW, Chan KP, Hui DS, Goddard JR, Shaw JG, Reid DW, Yang IA. Acute exacerbation of COPD. Respirology 2016; 21:1152-65. [PMID: 27028990 PMCID: PMC7169165 DOI: 10.1111/resp.12780] [Citation(s) in RCA: 195] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 12/18/2015] [Accepted: 01/20/2016] [Indexed: 01/14/2023]
Abstract
The literature of acute exacerbation of chronic obstructive pulmonary disease (COPD) is fast expanding. This review focuses on several aspects of acute exacerbation of COPD (AECOPD) including epidemiology, diagnosis and management. COPD poses a major health and economic burden in the Asia-Pacific region, as it does worldwide. Triggering factors of AECOPD include infectious (bacteria and viruses) and environmental (air pollution and meteorological effect) factors. Disruption in the dynamic balance between the 'pathogens' (viral and bacterial) and the normal bacterial communities that constitute the lung microbiome likely contributes to the risk of exacerbations. The diagnostic approach to AECOPD varies based on the clinical setting and severity of the exacerbation. After history and examination, a number of investigations may be useful, including oximetry, sputum culture, chest X-ray and blood tests for inflammatory markers. Arterial blood gases should be considered in severe exacerbations, to characterize respiratory failure. Depending on the severity, the acute management of AECOPD involves use of bronchodilators, steroids, antibiotics, oxygen and noninvasive ventilation. Hospitalization may be required, for severe exacerbations. Nonpharmacological interventions including disease-specific self-management, pulmonary rehabilitation, early medical follow-up, home visits by respiratory health workers, integrated programmes and telehealth-assisted hospital at home have been studied during hospitalization and shortly after discharge in patients who have had a recent AECOPD. Pharmacological approaches to reducing risk of future exacerbations include long-acting bronchodilators, inhaled steroids, mucolytics, vaccinations and long-term macrolides. Further studies are needed to assess the cost-effectiveness of these interventions in preventing COPD exacerbations.
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Affiliation(s)
- Fanny W Ko
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
| | - Ka Pang Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - David S Hui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - John R Goddard
- School of Medicine, The University of Queensland, Brisbane, Australia.,Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Hospital and Health District, Brisbane, Australia
| | - Janet G Shaw
- School of Medicine, The University of Queensland, Brisbane, Australia.,Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Hospital and Health District, Brisbane, Australia
| | - David W Reid
- School of Medicine, The University of Queensland, Brisbane, Australia.,Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Hospital and Health District, Brisbane, Australia.,Lung Infection and Inflammation Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Ian A Yang
- School of Medicine, The University of Queensland, Brisbane, Australia.,Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Hospital and Health District, Brisbane, Australia
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Miravitlles M, Vogelmeier C, Roche N, Halpin D, Cardoso J, Chuchalin AG, Kankaanranta H, Sandström T, Śliwiński P, Zatloukal J, Blasi F. A review of national guidelines for management of COPD in Europe. Eur Respir J 2016; 47:625-37. [PMID: 26797035 PMCID: PMC4733567 DOI: 10.1183/13993003.01170-2015] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 10/24/2015] [Indexed: 12/23/2022]
Abstract
The quality of care can be improved by the development and implementation of evidence-based treatment guidelines. Different national guidelines for chronic obstructive pulmonary disease (COPD) exist in Europe and relevant differences may exist among them.This was an evaluation of COPD treatment guidelines published in Europe and Russia in the past 7 years. Each guideline was reviewed in detail and information about the most important aspects of patient diagnosis, risk stratification and pharmacotherapy was extracted following a standardised process. Guidelines were available from the Czech Republic, England and Wales, Finland, France, Germany, Italy, Poland, Portugal, Russia, Spain and Sweden. The treatment goals, criteria for COPD diagnosis, consideration of comorbidities in treatment selection and support for use of long-acting bronchodilators, were similar across treatment guidelines. There were differences in measures used for stratification of disease severity, consideration of patient phenotypes, criteria for the use of inhaled corticosteroids and recommendations for other medications (e.g. theophylline and mucolytics) in addition to bronchodilators.There is generally good agreement on treatment goals, criteria for diagnosis of COPD and use of long-acting bronchodilators as the cornerstone of treatment among guidelines for COPD management in Europe and Russia. However, there are differences in the definitions of patient subgroups and other recommended treatments.
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Affiliation(s)
- Marc Miravitlles
- Pneumology Dept, University Hospital Vall d'Hebron, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Claus Vogelmeier
- Dept of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, German Center for Lung Research (DZL), Marburg, Germany
| | - Nicolas Roche
- Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital Cochin, University Paris Descartes (EA2511), Paris, France
| | | | - João Cardoso
- Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | - Hannu Kankaanranta
- Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland Dept of Respiratory Medicine, University of Tampere, Tampere, Finland
| | - Thomas Sandström
- Department of Public Health and Clinical Medicine, Medicine Unit, Umeå University, Umeå, Sweden
| | - Paweł Śliwiński
- 2nd Department of Respiratory Medicine, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Jaromir Zatloukal
- Dept of Respiratory Medicine, University Hospital Olomouc, Olomouc, Czech Republic
| | - Francesco Blasi
- Dept of Pathophysiology and Transplantation, Università degli Studi di Milano, IRCCS Fondazione Ospedale Maggiore Policlinico Cà Granda, Milan, Italy
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Ilesanmi RE, Gillespie BM, Adejumo PO, Chaboyer W. Tailoring International Pressure Ulcer Prevention Guidelines for Nigeria: A Knowledge Translation Study Protocol. Healthcare (Basel) 2015; 3:619-29. [PMID: 27417784 PMCID: PMC4939576 DOI: 10.3390/healthcare3030619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 07/02/2015] [Accepted: 07/03/2015] [Indexed: 11/18/2022] Open
Abstract
Background: The 2014 International Pressure Ulcer Prevention (PUP) Clinical Practice Guidelines (CPG) provides the most current evidence based strategies to prevent Pressure Ulcer (PU). The evidence upon which these guidelines have been developed has predominantly been generated from research conducted in developed countries. Some of these guidelines may not be feasible in developing countries due to structural and resource issues; therefore there is a need to adapt these guidelines to the context thus making it culturally acceptable. Aim: To present a protocol detailing the tailoring of international PUPCPG into a care bundle for the Nigerian context. Methods: Guided by the Knowledge to Action (KTA) framework, a two phased study will be undertaken. In Phase 1, the Delphi technique with stakeholder leaders will be used to review the current PUPCPG, identifying core strategies that are feasible to be adopted in Nigeria. These core strategies will become components of a PUP care bundle. In Phase 2, key stakeholder interviews will be used to identify the barriers, facilitators and potential implementation strategies to promote uptake of the PUP care bundle. Results: A PUP care bundle, with three to eight components is expected to be developed from Phase 1. Implementation strategies to promote adoption of the PUP care bundle into clinical practice in selected Nigerian hospitals, is expected to result from Phase 2. Engagement of key stakeholders and consumers in the project should promote successful implementation and translate into better patient care. Conclusion: Using KTA, a knowledge translation framework, to guide the implementation of PUPCPG will enhance the likelihood of successful adoption in clinical practice. In implementing a PUP care bundle, developing countries face a number of challenges such as the feasibility of its components and the required resources.
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Affiliation(s)
- Rose Ekama Ilesanmi
- Department of Nursing, College of Medicine, University of Ibadan, Ibadan 23402, Nigeria.
| | - Brigid M Gillespie
- NHMRC Centre of Research Excellence in Nursing, Centre for Health Practice Innovation, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland 4222, Australia.
| | - Prisca Olabisi Adejumo
- Department of Nursing, College of Medicine, University of Ibadan, Ibadan 23402, Nigeria.
| | - Wendy Chaboyer
- NHMRC Centre of Research Excellence in Nursing, Centre for Health Practice Innovation, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland 4222, Australia.
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Sirtuin 1 and aging theory for chronic obstructive pulmonary disease. Anal Cell Pathol (Amst) 2015; 2015:897327. [PMID: 26236580 PMCID: PMC4506835 DOI: 10.1155/2015/897327] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/15/2015] [Accepted: 06/17/2015] [Indexed: 02/07/2023] Open
Abstract
Chronic Obstructive Pulmonary disease (COPD) is an inflammatory syndrome that represents an increasing health problem, especially in the elderly population. Drug therapies are symptomatic and inadequate to contrast disease progression and mortality. Thus, there is an urgent need to clarify the molecular mechanisms responsible for this condition in order to identify new biomarkers and therapeutic targets. Processes including oxidant/antioxidant, protease/antiprotease, and proliferative/antiproliferative balance and control of inflammatory response become dysfunctional during aging as well as in COPD. Recently it was suggested that Sirtuin 1 (SIRT1), an antiaging molecule involved in the response to oxidative stress and chronic inflammation, is implicated in both development and progression of COPD. The present review focuses on the involvement of SIRT1 in the regulation of redox state, inflammation, and premature senescence, all crucial characteristics of COPD phenotypes. Recent evidence corroborating the statement of the “aging theory for COPD” was also discussed.
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