medwireNews: US study results show that primary care management of chronic obstructive pulmonary disease (COPD) rarely conforms to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines.
The research, based on data from 1517 COPD patients, found that fewer than 3% of patients received treatment in line with all three primary care components of the 2007 guidelines, and 65% had not undergone any spirometry testing within the prior year.
"These findings are concerning, since without appropriate lung function documentation via spirometry, it is difficult for providers to treat patients with COPD to GOLD treatment guidelines," say Jenifer Wogen (MedMentis Consulting LLC, Towaco, New Jersey) and colleagues.
The researchers analyzed data taken from 11 primary care organizations. They assessed whether patients were treated according to the adapted GOLD primary care guidelines, which include three components: diagnosis (spirometry data within prior year); comorbid conditions (appropriate management of diabetes, hypertension, and depression); and risk reduction (counseling on smoking cessation, receipt of pneumococcal and flu vaccination).
Overall, 63.3% of patients met the criteria for one or more guideline components, with only 15.8% meeting two, and 2.5% meeting all three.
While 35.5% of patients had spirometry performed within the prior year, only 26.9% had a current forced expiratory volume in 1 second to forced vital capacity ratio recorded in their primary care notes.
With regards to the other components of the guidelines, blood pressure was controlled in 72.0% of nondiabetic patients, and 42.2% of patients with diabetes, while hemoglobin A1C levels were below 7.0 % in 55.7% of patients with diabetes. Rates of depression screening, smoking cessation counseling, and vaccination were 38.3%, 34.0%, and 38.0%, respectively.
Notably, the 36.5% of patients who had a pulmonologist involved in their care were 1.7 times more likely to meet at least one guideline component criterion than patients only seen in primary care.
The authors say their results show that efforts are needed to increase the knowledge and application of GOLD guidelines among primary care physicians.
"Our study's findings suggest a disconnect between COPD primary care management guidelines and care of COPD patients in usual-care practice, and are disconcerting given that the majority of COPD patients are managed within a primary care setting," they comment in Current Medical Research and Opinion.
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