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

Bibliographic Details
Title: Adherence to the GOLD Guidelines in Primary Care: Data from the Swiss COPD Cohort.
Authors: Mangold, Veronika, Boesing, Maria, Berset, Camille, Bridevaux, Pierre-Olivier, Geiser, Thomas, Joos Zellweger, Ladina, Kohler, Malcolm, Lüthi-Corridori, Giorgia, Maier, Sabrina, Miedinger, David, Thurnheer, Robert, von Garnier, Christophe, Leuppi, Jörg Daniel
Source: Journal of Clinical Medicine; Oct2023, Vol. 12 Issue 20, p6636, 15p
Subject Terms: OBSTRUCTIVE lung diseases, CHRONIC obstructive pulmonary disease, PRIMARY care, GOLD
Abstract: (1) Introduction: Chronic obstructive pulmonary disease (COPD) and its associated morbidity and mortality are a global burden on both affected patients and healthcare systems. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) issues guidelines with the aim of improving COPD management. Previous studies reported significant variability in adherence to these recommendations. The objective of this study was to evaluate Swiss primary practitioners' adherence to the GOLD guidelines for the pharmacological treatment of stable COPD. (2) Methods: We studied patients who were included in the Swiss COPD cohort study, an ongoing prospective study in a primary care setting, between 2015 and 2022. The key inclusion criteria are age ≥ 40 years, FEV1/FVC ratio < 70%, and a smoking history of at least 20 pack-years. Adherence to the GOLD guidelines was assessed per visit and over time. (3) Results: The data of 225 COPD patients (mean age 67 ± 9 years, 64% male) and their respective 1163 visits were analyzed. In 65% of visits (726/1121), treatment was prescribed according to the GOLD guidelines. Non-adherence was most common in GOLD groups A and B (64% and 33%) and mainly consisted of over-treatment (two long-acting bronchodilators in group A (98/195, 50%) and ICS in groups A (21/195, 11%) and B (198/808, 25%)). In group D, the prescriptions conformed with the guidelines in 99% of cases (109/108). Guideline adherence was associated with high symptom load (COPD Assessment Test) (OR 1.04, p = 0.002), high number of exacerbations (OR = 2.07, p < 0.001), asthma overlap (OR 3.36, p = 0.049), and diabetes mellitus (OR 2.82, p = 0.045). (4) Conclusion: These results confirm a conflict between the GOLD recommendations and primary practice, mainly concerning over-treatment in GOLD groups A and B. Patients with high symptom load, high exacerbation risk, asthma overlap, and diabetes mellitus are more likely to be treated in conformity with the guidelines. Further research is needed to uncover the reasons for the discrepancies and to design strategies for improvement. [ABSTRACT FROM AUTHOR]
Copyright of Journal of Clinical Medicine is the property of MDPI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Complementary Index
More Details
ISSN:20770383
DOI:10.3390/jcm12206636
Published in:Journal of Clinical Medicine
Language:English