Level of adherence to the GOLD strategy document for management of patients admitted to hospital with an acute exacerbation of COPD

作者：Tang Clarice Y^*; Taylor Nicholas F; McDonald Christine F; Blackstock Felicity C

来源：Respirology, 2014, 19(8): 1191-1197.

DOI：10.1111/resp.12361

• acute disease
• chronic obstructive
• guideline adherence
• inpatient
• pulmonary disease

Background and objectiveThe Global initiative for chronic Obstructive Lung Disease (GOLD) strategy document has been available since 2001. Little is known about level of adherence to the GOLD document among hospital-based health professionals assessing and managing inpatients admitted with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The primary aim of the study was to evaluate the level of adherence among health professionals to GOLD. %26lt;br%26gt;MethodsA retrospective audit of medical histories was completed on a random sample of 240 patients admitted to hospital with a primary diagnosis of AECOPD within a calendar year. The audit evaluated adherence to GOLD recommendations on appropriateness of hospital and intensive care unit admissions as well as pharmacological and non-pharmacological management. %26lt;br%26gt;ResultsHigh levels of adherence to indications for hospital admissions (97%), indications for intensive care unit admissions (100%) and prescription of bronchodilators (100%) were observed. However, antibiotics (45%) and oxygen therapy (68%) were over-prescribed. Adherence to non-pharmacological management was poor in areas such as smoking cessation (25%) and pulmonary rehabilitation referrals (16%). Patients admitted under the care of the respiratory team were more likely (odds ratio=2.6, 95% confidence interval: 1.3-5.4) to be referred to pulmonary rehabilitation than patients admitted under the general medicine team. %26lt;br%26gt;ConclusionsHealth professionals in the respiratory team had better adherence to GOLD as compared to health professionals in other teams. Nonetheless, pharmacological interventions were both appropriately prescribed and also over-prescribed, whereas non-pharmacological interventions were used rarely, suggesting a need for practice review in these areas. %26lt;br%26gt;This study evaluated the level of adherence to the GOLD document among health professionals treating inpatients with an acute exacerbation of COPD. Pharmacological interventions were both prescribed appropriately and also over-prescribed, whereas non-pharmacological interventions were rarely recommended, suggesting a need to review practice in these areas.

• 出版日期2014-11