Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555-0561, USA.
Respir Med. 2013 Jul;107(7):1046-52. doi: 10.1016/j.rmed.2013.04.001. Epub 2013 Apr 30.
Chronic obstructive pulmonary disease (COPD) is the only leading cause of death with rising morbidity and mortality. Clinical practice guidelines (CPGs) to optimize pharmacotherapy for patients with COPD have been updated based on promising results of randomized clinical trials. We examined the frequency of and factors associated with guideline adherence by physicians in clinical practice at an academic medical center.
Patients with a clinical diagnosis of COPD, confirmed by spirometry, who presented to the ambulatory clinics, were enrolled. The primary outcome was provider's adherence to the 2007 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Subjects were categorized as guideline-concordant who received a rescue inhaler (all patients), or at least one long-acting bronchodilator (stage II), or at least one long-acting bronchodilator plus an inhaled corticosteroid (stage III-IV). Demographics, clinical information and type of provider were recorded. Provider type was classified as primary care physician (PCP), pulmonologist, or co-management by both.
Among 450 subjects who met study criteria, 246 (54.7%) received guideline-concordant treatment. Age, sex, race, disease severity, and co-morbidities were not associated with guideline adherence. Multivariate analysis showed that patients co-managed by a PCP and pulmonologist had a higher likelihood of receiving guideline-concordant treatment than those managed by one or the other (Odds Ratio: 4.59; 95% Confidence Interval: 2.92, 7.22, p < 0.001).
Just over half of stable COPD patients receive guideline-concordant care. Co-management by a PCP and pulmonologist increases the likelihood of receiving guideline-concordant inhaler therapy.
慢性阻塞性肺疾病（COPD）是唯一发病率和死亡率不断上升的主要致死原因。临床实践指南（CPGs）已根据随机临床试验的有希望结果进行了更新，以优化 COPD 患者的药物治疗。我们在学术医疗中心的临床实践中检查了医生遵循指南的频率和相关因素。
我们招募了在门诊诊所就诊并经肺量计检查确诊为 COPD 的患者。主要结局是医生在临床实践中遵循 2007 年全球慢性阻塞性肺疾病倡议（GOLD）指南的情况。将患者分为符合指南的组（所有患者均接受急救吸入器，或至少接受一种长效支气管扩张剂（II 期），或至少一种长效支气管扩张剂加吸入皮质类固醇（III-IV 期））。记录了受试者的人口统计学，临床信息和医生类型。将医生类型分为初级保健医生（PCP），肺病专家或两者共同管理。
在符合研究标准的 450 名患者中，有 246 名（54.7％）接受了符合指南的治疗。年龄，性别，种族，疾病严重程度和合并症与遵循指南无关。多变量分析显示，与由一名或另一名医生管理的患者相比，由 PCP 和肺病专家共同管理的患者接受符合指南的治疗的可能性更高（优势比：4.59；95％置信区间：2.92，7.22，p <0.001）。
只有一半以上的稳定 COPD 患者接受了符合指南的治疗。由 PCP 和肺病专家共同管理可提高接受符合指南的吸入器治疗的可能性。
