Which chronic obstructive pulmonary disease care recommendations have low implementation and why? A pilot study

BMC Research Notes

Peter Frith⁴  Ral Antic³  Mary Young¹  Karen Grimmer-Somers²  Kylie Johnston² 

[1] Transitional and Community Service, Royal Adelaide Hospital, Adelaide, Australia;International Centre for Allied Health Evidence, Division of Health Sciences, University of South Australia, Adelaide, Australia;Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia;Respiratory, Allergy and Sleep Services, Repatriation General Hospital and Flinders University, Adelaide, Australia

关键词: Pulmonary rehabilitation;    Chronic obstructive pulmonary disease;    Guidelines;    Implementation;   

Others  :  1165132
DOI  :  10.1186/1756-0500-5-652

 received in 2012-09-17, accepted in 2012-10-22,  发布年份 2012

【 摘 要 】

Background

Clinical care components for people with COPD are recommended in guidelines if high-level evidence exists. However, there are gaps in their implementation, and factors which act as barriers or facilitators to their uptake are not well described. The aim of this pilot study was to explore implementation of key high-evidence COPD guideline recommendations in patients admitted to hospital with a disease exacerbation, to inform the development of a larger observational study.

Methods

This study recruited consecutive COPD patients admitted to a tertiary hospital. Patient demographic, disease and admission characteristics were recorded. Information about implementation of target guideline recommendations (smoking cessation, pulmonary rehabilitation referral, influenza vaccination, medication use and long-term oxygen use if hypoxaemic) was gained from medical records and patient interviews. Interviews with hospital-based doctors examined their perspectives on recommendation implementation.

Results

Fifteen patients (aged 76(9) years, FEV₁%pred 58(15), mean(SD)) and nine doctors participated. Referral to pulmonary rehabilitation (5/15 patients) was underutilised by comparison with other high-evidence recommendations. Low awareness of pulmonary rehabilitation was a key barrier for patients and doctors. Other barriers for patients were access difficulties, low perceived health benefits, and co-morbidities. Doctors reported they tended to refer patients with severe disease and frequent hospital attendance, a finding supported by the quantitative data.

Conclusions

This study provides justification for a larger observational study to test the hypothesis that pulmonary rehabilitation referral is low in suitable COPD patients, and closer investigation of the reasons for this evidence-practice gap.

【 授权许可】

   
2012 Johnston et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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