Adherence to the GOLD Guidelines in Primary Care: Data from the Swiss COPD Cohort
(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 managemen...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-10-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/20/6636 |
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| author | Veronika Mangold Maria Boesing Camille Berset Pierre-Olivier Bridevaux Thomas Geiser Ladina Joos Zellweger Malcolm Kohler Giorgia Lüthi-Corridori Sabrina Maier David Miedinger Robert Thurnheer Christophe von Garnier Jörg Daniel Leuppi |
| author_facet | Veronika Mangold Maria Boesing Camille Berset Pierre-Olivier Bridevaux Thomas Geiser Ladina Joos Zellweger Malcolm Kohler Giorgia Lüthi-Corridori Sabrina Maier David Miedinger Robert Thurnheer Christophe von Garnier Jörg Daniel Leuppi |
| author_sort | Veronika Mangold |
| collection | DOAJ |
| description | (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, <i>p</i> = 0.002), high number of exacerbations (OR = 2.07, <i>p</i> < 0.001), asthma overlap (OR 3.36, <i>p</i> = 0.049), and diabetes mellitus (OR 2.82, <i>p</i> = 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. |
| first_indexed | 2024-03-10T21:10:00Z |
| format | Article |
| id | doaj.art-8913e19ce79545b082a4cddf8296ffcc |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T21:10:00Z |
| publishDate | 2023-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-8913e19ce79545b082a4cddf8296ffcc2023-11-19T16:53:53ZengMDPI AGJournal of Clinical Medicine2077-03832023-10-011220663610.3390/jcm12206636Adherence to the GOLD Guidelines in Primary Care: Data from the Swiss COPD CohortVeronika Mangold0Maria Boesing1Camille Berset2Pierre-Olivier Bridevaux3Thomas Geiser4Ladina Joos Zellweger5Malcolm Kohler6Giorgia Lüthi-Corridori7Sabrina Maier8David Miedinger9Robert Thurnheer10Christophe von Garnier11Jörg Daniel Leuppi12University Center of Internal Medicine, Cantonal Hospital Baselland, 4410 Liestal, SwitzerlandUniversity Center of Internal Medicine, Cantonal Hospital Baselland, 4410 Liestal, SwitzerlandUniversity Center of Internal Medicine, Cantonal Hospital Baselland, 4410 Liestal, SwitzerlandClinic of Pneumology, Hospital of Valais, University of Geneva, 1205 Geneva, SwitzerlandDepartment of Pulmonary Medicine and Allergology, University Hospital, University of Bern, 3010 Bern, SwitzerlandDepartment of Pneumology, Claraspital, 4058 Basel, SwitzerlandDepartment of Pneumology, University Hospital Zürich, 8091 Zürich, SwitzerlandUniversity Center of Internal Medicine, Cantonal Hospital Baselland, 4410 Liestal, SwitzerlandUniversity Center of Internal Medicine, Cantonal Hospital Baselland, 4410 Liestal, SwitzerlandUniversity Center of Internal Medicine, Cantonal Hospital Baselland, 4410 Liestal, SwitzerlandClinic of Medicine, Department of Pneumology, Cantonal Hospital Münsterlingen, 8596 Münsterlingen, SwitzerlandDivision of Pulmonology, Department of Medicine, University Hospital Lausanne, CHUV, University of Lausanne, 1011 Lausanne, SwitzerlandUniversity Center of Internal Medicine, Cantonal Hospital Baselland, 4410 Liestal, Switzerland(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, <i>p</i> = 0.002), high number of exacerbations (OR = 2.07, <i>p</i> < 0.001), asthma overlap (OR 3.36, <i>p</i> = 0.049), and diabetes mellitus (OR 2.82, <i>p</i> = 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.https://www.mdpi.com/2077-0383/12/20/6636COPDGOLD guidelinesadherenceprimary careinhaled corticosteroidsbronchodilators |
| spellingShingle | Veronika Mangold Maria Boesing Camille Berset Pierre-Olivier Bridevaux Thomas Geiser Ladina Joos Zellweger Malcolm Kohler Giorgia Lüthi-Corridori Sabrina Maier David Miedinger Robert Thurnheer Christophe von Garnier Jörg Daniel Leuppi Adherence to the GOLD Guidelines in Primary Care: Data from the Swiss COPD Cohort Journal of Clinical Medicine COPD GOLD guidelines adherence primary care inhaled corticosteroids bronchodilators |
| title | Adherence to the GOLD Guidelines in Primary Care: Data from the Swiss COPD Cohort |
| title_full | Adherence to the GOLD Guidelines in Primary Care: Data from the Swiss COPD Cohort |
| title_fullStr | Adherence to the GOLD Guidelines in Primary Care: Data from the Swiss COPD Cohort |
| title_full_unstemmed | Adherence to the GOLD Guidelines in Primary Care: Data from the Swiss COPD Cohort |
| title_short | Adherence to the GOLD Guidelines in Primary Care: Data from the Swiss COPD Cohort |
| title_sort | adherence to the gold guidelines in primary care data from the swiss copd cohort |
| topic | COPD GOLD guidelines adherence primary care inhaled corticosteroids bronchodilators |
| url | https://www.mdpi.com/2077-0383/12/20/6636 |
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