Raghavan Deepa, Drummond Karen L, Sanders Sonya A, Kirchner JoAnn
Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, USA.
Pulmonary and Critical Care Medicine Section, Central Arkansas Veterans Healthcare System, Little Rock, United States.
Chron Respir Dis. 2025 Jan-Dec;22:14799731251314870. doi: 10.1177/14799731251314870.
Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory disease with high morbidity and mortality. COPD guidelines (CPG) are greatly underutilized and studies attempting to improve this practice gap have yielded inconsistent results. We hypothesize that using implementation science can provide a detailed understanding of these practice gaps and the reasons behind them. Since primary care (PC) manages the bulk of COPD patients, in this pilot study, we use principles of implementation science to systematically explore the reasons for this implementation gap in a PC setting. We used the Consolidated Framework of Implementation Science (CFIR), a determinant framework to design semi-structured interview guides to conduct multistakeholder interviews to explore the barriers and facilitators to four key COPD-CPG with known poor uptake: inhaler education, spirometry, pulmonary rehabilitation and COPD-specific patient education from patient and provider perspectives. Qualitative analysis was performed using rapid analysis. Seventeen respondents including both, patients and providers were interviewed. All these COPD-CPG were rated as 'highly important' suggesting that perceived importance alone is insufficient to bridge gaps in uptake. Respondents were least familiar with pulmonary rehabilitation. Physician time constraint was a significant reported barrier. There exist multilevel contextual barriers to each of these COPD-CPG. To increase uptake of COPD guidelines, implementation efforts that address multilevel barriers and promote collaborative care by use of non-physician resources are likely to have higher buy-in and greater chances for success.
慢性阻塞性肺疾病（COPD）是一种发病率和死亡率都很高的进行性呼吸系统疾病。慢性阻塞性肺疾病指南（CPG）的利用率极低，旨在缩小这一实践差距的研究结果并不一致。我们假设，运用实施科学能够详细了解这些实践差距及其背后的原因。由于初级保健（PC）管理着大部分慢性阻塞性肺疾病患者，在这项试点研究中，我们运用实施科学原则，系统地探究在初级保健环境中出现这种实施差距的原因。我们使用实施科学综合框架（CFIR），这是一个决定因素框架，用于设计半结构化访谈指南，以进行多利益相关方访谈，从患者和提供者的角度探讨吸入器教育、肺活量测定、肺康复以及慢性阻塞性肺疾病特定患者教育这四项已知接受度较低的关键慢性阻塞性肺疾病指南的障碍和促进因素。采用快速分析法进行定性分析。共访谈了包括患者和提供者在内的17名受访者。所有这些慢性阻塞性肺疾病指南都被评为“极其重要”，这表明仅靠认知重要性不足以弥合接受度方面的差距。受访者对肺康复最不熟悉。医生的时间限制是一个显著的障碍。这些慢性阻塞性肺疾病指南中的每一项都存在多层次的背景障碍。为了提高慢性阻塞性肺疾病指南的接受度，解决多层次障碍并通过使用非医生资源促进协作护理的实施努力可能会获得更高的认同度和更大的成功机会。
