title: Guideline adherence in management of stable chronic obstructive pulmonary disease.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors: Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555-0561, USA. roozbeh.sharif@gmail.com
authors: Roozbeh
authors: R
authors: Sharif
authors: Christel R
authors: CR
authors: Cuevas
authors: Yue
authors: Y
authors: Wang
authors: Mohit
authors: M
authors: Arora
authors: Gulshan
authors: G
authors: Sharma
mesh_terms: D000046:Academic Medical Centers / Q000592:standards; D000368:Aged; D000554:Ambulatory Care Facilities / Q000592:standards; D001993:Bronchodilator Agents / Q000627:therapeutic use; D003299:Cooperative Behavior; D019468:Disease Management; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000503:physiopathology; D012189:Retrospective Studies; D013781:Texas
chemical_list: D001993:Bronchodilator Agents; D005938:Glucocorticoids