title: Investigation of barriers to clinical practice guideline-recommended pharmacotherapy in the treatment of COPD.
abstract: BACKGROUND
  The adoption of clinical practice guideline recommendations for COPD is suboptimal. Determining the barriers to the implementation of these practice guidelines may help improve patient care.
  
  
  OBJECTIVE
  To determine whether barriers to the use of pharmacotherapy according to practice guidelines are related primarily to patient or prescriber factors.
  
  
  METHODS
  Retrospective cohort study. Members of a health maintenance organization identified as having spirometry-defined COPD ranging from stage II to IV. Electronic medical records were reviewed for documentation of the following: 1) patient affordability issues, 2) history of an adverse drug reaction, 3) history of inefficacy to therapy, and 4) prescription history.
  
  
  RESULTS
  A total of 111 medical records were reviewed. There were 51% of patients who had not filled medications that had been prescribed in accordance with guidelines and 43% did not have the guideline recommended medications prescribed in the previous year. Only 4% and 2% of patients had documented inefficacy and affordability issues, respectively. There were no reported cases of adverse drug reactions.
  
  
  CONCLUSIONS
  This study provides insight to the acceptance of COPD treatment recommendations by patients and providers. Further research is needed to design interventions to reduce barriers and optimize COPD treatment.
authors.affiliation: Clinical Pharmacy Primary Care Specialty Resident, Kaiser Permanente Colorado, Denver, CO ( USA ).
authors.forename: Lea
authors.initials: L
authors.lastname: Price
authors.affiliation: Clinical Pharmacy Specialist at Kaiser Permanente Colorado, Denver, CO. Clinical Assistant Professor, School of Pharmacy, University of Colorado at Denver and Health Sciences Center, Denver, CO ( USA ).
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Billups
authors.affiliation: Clinical Pharmacy Specialist at Kaiser Permanente Colorado, Denver, CO. Clinical Assistant Professor, School of Pharmacy, University of Colorado at Denver and Health Sciences Center, Denver, CO ( USA ).
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Rice
authors.affiliation: Clinical Assistant Professor, School of Pharmacy, University of Colorado at Denver and Health Sciences Center, Denver, CO ( USA ).
authors.forename: Cynthia
authors.initials: C
authors.lastname: Hartsfield
keywords: Chronic Obstructive; Drug Therapy; Patient Compliance; Practice Guidelines; Pulmonary Disease; United States