Adherence to GOLD Recommendations among Swiss Pulmonologists and General Practitioners. (8th December 2020)

• Record Type: Journal Article
• Authors: Marmy, Joana Louise; Diedrich, Jens Peter; Cadus, Cordula; Grendelmeier, Peter; Tschacher, Anne; Dieterle, Thomas; Chhajed, Prashant N.; Leuppi, Jörg Daniel
• Is Part Of: COPD. Volume 18:Number 1(2021)
• Page Start: 9
• Page End: 15
• Publication Date: 2020-12-08
• Subjects: COPD -- dyspnea -- pharmacological treatment -- guideline adherence -- survey; Lungs -- Diseases, Obstructive -- Periodicals; 616.24
• DOI: 10.1080/15412555.2020.1859469
• Languages: English
• ISSNs: 1541-2555

Abstract

Abstract: Significant variability in adherence to COPD management recommendations has been reported. We aimed to evaluate real-life COPD pharmacotherapy prescribing patterns and adherence to the 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) global strategy in Switzerland. A questionnaire-based survey was conducted among Swiss general practitioners (GPs) and pulmonologists (PULs) from May 1 to November 30, 2017. Participants were invited to complete a questionnaire on their next 5–10 consecutive patients already receiving a pharmacological treatment for COPD. They were requested to assess dyspnea using the modified Medical Research Council (mMRC) dyspnea scale and to determine whether a treatment adjustment was indicated. Fifty-three PULs and 39 GPs completed questionnaires on 511 COPD patients. Dyspnea with mMRC grade ≥2 was reported in 62.5% of the patients, and 31.9% had had at least two exacerbations (or at least one with hospital admission) in the last 12 months. The vast majority (87.1%) of GOLD A patients were overtreated. In the GOLD B group, 52.2% of prescriptions were concordant with GOLD 2017 recommendations, but 37% of patients were overtreated. Among GOLD C patients, 49.2% received GOLD-adherent treatment and 47.5% were overtreated. In the GOLD D category, 78.8% of the patients received a treatment consistent with recommendations but 15.2% were undertreated. After reassessment of patient status, treatment was modified in 50.3% of the patients. This study confirms that discordance of real-world prescription patterns with international guidance is frequent. Further educational efforts are required to improve adherence to COPD management recommendations.