title: Level of adherence to the GOLD strategy document for management of patients admitted to hospital with an acute exacerbation of COPD.
abstract: OBJECTIVE
  The Global initiative for chronic Obstructive Lung Disease (GOLD) strategy document has been available since 2001. Little is known about level of adherence to the GOLD document among hospital-based health professionals assessing and managing inpatients admitted with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The primary aim of the study was to evaluate the level of adherence among health professionals to GOLD.
  
  
  METHODS
  A retrospective audit of medical histories was completed on a random sample of 240 patients admitted to hospital with a primary diagnosis of AECOPD within a calendar year. The audit evaluated adherence to GOLD recommendations on appropriateness of hospital and intensive care unit admissions as well as pharmacological and non-pharmacological management.
  
  
  RESULTS
  High levels of adherence to indications for hospital admissions (97%), indications for intensive care unit admissions (100%) and prescription of bronchodilators (100%) were observed. However, antibiotics (45%) and oxygen therapy (68%) were over-prescribed. Adherence to non-pharmacological management was poor in areas such as smoking cessation (25%) and pulmonary rehabilitation referrals (16%). Patients admitted under the care of the respiratory team were more likely (odds ratio = 2.6, 95% confidence interval: 1.3-5.4) to be referred to pulmonary rehabilitation than patients admitted under the general medicine team.
  
  
  CONCLUSIONS
  Health professionals in the respiratory team had better adherence to GOLD as compared to health professionals in other teams. Nonetheless, pharmacological interventions were both appropriately prescribed and also over-prescribed, whereas non-pharmacological interventions were used rarely, suggesting a need for practice review in these areas.
authors.affiliation: Department of Physiotherapy, La Trobe University, Melbourne, Victoria, Australia; Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia.
authors.forename: Clarice Y
authors.initials: CY
authors.lastname: Tang
authors.forename: Nicholas F
authors.initials: NF
authors.lastname: Taylor
authors.forename: Christine F
authors.initials: CF
authors.lastname: McDonald
authors.forename: Felicity C
authors.initials: FC
authors.lastname: Blackstock
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001315:Australia; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D054869:Clinical Audit; D005260:Female; D019983:Guideline Adherence / Q000592:standards / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy / Q000379:methods; D010346:Patient Care Management / Q000379:methods / Q000592:standards; D017410:Practice Guidelines as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000628:therapy; D012189:Retrospective Studies; D016540:Smoking Cessation
chemical_list: D000900:Anti-Bacterial Agents; D001993:Bronchodilator Agents
keywords: acute disease; chronic obstructive; guideline adherence; inpatient; pulmonary disease