[Discrepancy between the guidelines and practice by family physicians in treating adults with an exacerbation of asthma or chronic obstructive pulmonary disease].
OBJECTIVE
To analyse to what extent current management of exacerbation in adult asthmatics and patients with asthma or chronic obstructive pulmonary disease (COPD) in general practice is consistent with the guidelines from the standard 'asthma/COPD in adults' of the Dutch College of General Physicians (NHG).


METHODS
Cross-sectional, prospective.


METHODS
Centre for Quality of Care Research, University of Nijmegen, the Netherlands.


METHODS
Fifty-two GPs in 1992 during an average of 3.5 months in adult patients with exacerbation of asthma or COPD prospectively registered the severity of the dyspnoea, productiveness of coughing, colour of phlegm, fever, auscultatory findings, patients' age and sex and use of medication. Current management (peak flow measurement, prescriptions) was related to all these data and compared with that recommended in the current NHG standard.


RESULTS
Data were available on 383 exacerbations. Peak flow measurement was used diagnostically in 27% of the exacerbations. Inhalation steroids were prescribed in 26% of the cases (new or step-up), oral steroids were prescribed in 24%, more often in exacerbations with severe dyspnoea (48%; p < 0.0005), in patients who prior to the exacerbations had been using two or more different COPD drugs (37%; p < 0.0005) and in patients over 55 years of age (35%; p < 0.0005). Antibiotics were prescribed in 60% of the cases, and more often in case of coloured phlegm (83%; p < 0.0005) and of fever (91%; p < 0.0005).


CONCLUSIONS
Objectivation of the bronchial obstruction by peak flow measurement was done less often than recommended in the standard; antibiotics were prescribed more often and steroids less often. In order to reduce the substantial discrepancy between the guidelines and the actual management, implementation should be aimed at changing GPs' routines, with special attention for barriers to change.
Smeele
I J
IJ
Werkgroep Onderzoek Kwaliteit, Katholieke Universiteit, Nijmegen.
Van Schayck
C P
CP
Van Den Bosch
W J
WJ
Van Den Hoogen
H J
HJ
Muris
J W
JW
Grol
R P
RP
D000328:Adult; D000368:Aged; D001249:Asthma / Q000628:therapy*; D003430:Cross-Sectional Studies; D005194:Family Practice / Q000592:standards; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies
Discrepantie tussen de richtlijnen en het handelen van huisartsen bij volwassenen met exacerbatie van cara.