title: Why are some evidence-based care recommendations in chronic obstructive pulmonary disease better implemented than others? Perspectives of medical practitioners.
abstract: BACKGROUND
  Clinical guidelines for management of patients with chronic obstructive pulmonary disease (COPD) include recommendations based on high levels of evidence, but gaps exist in their implementation. The aim of this study was to examine the perspectives of medical practitioners regarding implementation of six high-evidence recommendations for the management of people with COPD.
  
  
  METHODS
  Semi-structured interviews were conducted with medical practitioners involved with care of COPD patients in hospital and general practice. Interviews sought medical practitioners' experience regarding implementation of smoking cessation, influenza vaccination, pulmonary rehabilitation, guideline-based medications, long-term oxygen therapy for hypoxemia and plan and advice for future exacerbations. Interviews were audiotaped, transcribed verbatim and analyzed using content analysis.
  
  
  RESULTS
  Nine hospital-based medical practitioners and seven general practitioners participated. Four major categories were identified which impacted on implementation of the target recommendations in the care of patients with COPD: (1) role clarity of the medical practitioner; (2) persuasive communication with the patient; (3) complexity of behavioral change required; (4) awareness and support available at multiple levels. For some recommendations, strength in all four categories provided significant enablers supporting implementation. However, with regard to pulmonary rehabilitation and plans and advice for future exacerbations, all identified categories that presented barriers to implementation.
  
  
  CONCLUSIONS
  This study of medical practitioner perspectives has indicated areas where significant barriers to the implementation of key evidence-based recommendations in COPD management persist. Developing strategies to target the identified categories provides an opportunity to achieve greater implementation of those high-evidence recommendations in the care of people with COPD.
authors.affiliation: International Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia, Australia. kylie.johnston@unisa.edu.au
authors.forename: Kylie N
authors.initials: KN
authors.lastname: Johnston
authors.forename: Mary
authors.initials: M
authors.lastname: Young
authors.forename: Karen A
authors.initials: KA
authors.lastname: Grimmer-Somers
authors.forename: Ral
authors.initials: R
authors.lastname: Antic
authors.forename: Peter A
authors.initials: PA
authors.lastname: Frith
mesh_terms: D001291:Attitude of Health Personnel; D001364:Awareness; D019317:Evidence-Based Medicine; D058005:General Practitioners / Q000523:psychology*; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D020445:Hospitalists; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage; D007407:Interviews as Topic; D010349:Patient Compliance; D010465:Perception; D010565:Persuasive Communication; D010819:Physician's Role; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000628:therapy*; D012138:Respiratory Therapy; D016540:Smoking Cessation; D013021:South Australia
chemical_list: D007252:Influenza Vaccines