Back to Browse Journals » International Journal of Chronic Obstructive Pulmonary Disease » Volume 6

Barriers to adherence to chronic obstructive pulmonary disease guidelines by primary care physicians

Authors Gregory D Salinas, James C Williamson, Ravi Kalhan, et al

Published 28 February 2011 Volume 2011:6 Pages 171—179

DOI http://dx.doi.org/10.2147/COPD.S16396

Review by Single-blind

Peer reviewer comments 3

Gregory D Salinas1, James C Williamson1, Ravi Kalhan2, Byron Thomashow3, Jodi L Scheckermann4, John Walsh5, Maziar Abdolrasulnia1, Jill A Foster1
1CE Outcomes, LLC Birmingham, AL, USA; 2Asthma-COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; 3Division of Pulmonary, Allergy, Critical Care, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA; 4Boehringer-Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA; 5COPD Foundation, Miami, FL, USA

Purpose: Even with the dissemination of several clinical guidelines, chronic obstructive pulmonary disease (COPD) remains underdiagnosed and mismanaged by many primary care physicians (PCPs). The objective of this study was to elucidate barriers to consistent implementation of COPD guidelines.
Patients and methods: A cross-sectional study implemented in July 2008 was designed to assess attitudes and barriers to COPD guideline usage.
Results: Five hundred US PCPs (309 family medicine physicians, 191 internists) were included in the analysis. Overall, 23.6% of the surveyed PCPs reported adherence to spirometry guidelines over 90% of the time; 25.8% reported adherence to guidelines related to long-acting bronchodilator (LABD) use in COPD patients. In general, physicians were only somewhat familiar with COPD guidelines, and internal medicine physicians were significantly more familiar than family physicians (P < 0.05). In a multivariate model controlling for demographics and barriers to guideline adherence, we found significant associations with two tested guideline components. Adherence to spirometry guidelines was associated with agreement with guidelines, confidence in interpreting data, ambivalence to outcome expectancy, and ability to incorporate spirometry into patient flow. Adherence to LABD therapy guidelines was associated with agreement with guidelines and confidence in gauging pharmacologic response.
Conclusions: Adherence to guideline recommendations of spirometry use was predicted by agreement with the recommendations, self-efficacy, perceived outcome expectancy if recommendations were adhered to, and resource availability. Adherence to recommendations of LABD use was predicted by agreement with guideline recommendations and self-efficacy. Increasing guideline familiarity alone may have limited patient outcomes, as other barriers, such as low confidence and outcome expectancy, are more likely to impact guideline adherence.

Keywords: COPD, primary care, barriers, guideline adoption

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF] View Full Text [HTML] 

 

Other articles by this author:

Primary care physician attitudes and perceptions of the impact of FDA-proposed REMS policy on prescription of extended-release and long-acting opioids

Salinas GD, Robinson CO, Abdolrasulnia M

Journal of Pain Research 2012, 5:363-369

Published Date: 5 October 2012

Communication gaps between physicians and patients with postherpetic neuralgia: results from a national study on practice patterns

Glauser TA, Salinas GD, Nevins H, Williamson JC, Wallace MS, Abdolrasulnia M

Journal of Pain Research 2011, 4:407-415

Published Date: 9 December 2011

Readers of this article also read:

Increasing the oral bioavailability of poorly water-soluble carbamazepine using immediate-release pellets supported on SBA-15 mesoporous silica [Erratum]

Wang Z, Chen B, Quan G, Li F, Wu Q, Dian L, Dong Y, Li G, Wu C

International Journal of Nanomedicine 2013, 8:627-628

Published Date: 7 February 2013

Enhanced bioavailability of sirolimus via preparation of solid dispersion nanoparticles using a supercritical antisolvent process

Kim MS, Kim JS, Park HJ, Cho WK, Cha KH, Hwang SJ

International Journal of Nanomedicine 2011, 6:2997-3009

Published Date: 24 November 2011

Asthma, chronic obstructive pulmonary disease, or both? Diagnostic labeling and spirometry in primary care patients aged 40 years or more

Melbye H, Drivenes E, Dalbak LG, Leinan T, Høegh-Henrichsen S, Østrem A

International Journal of Chronic Obstructive Pulmonary Disease 2011, 6:597-603

Published Date: 17 November 2011

Ultrasonic synthetic technique to manufacture a pHEMA nanopolymeric-based vaccine against the H6N2 avian influenza virus: a preliminary investigation

Poinern GEJ, Thi Le X, Shan S, Ellis T, Fenwick S, Edwards J, Fawcett D

International Journal of Nanomedicine 2011, 6:2167-2174

Published Date: 28 September 2011

Softec HD hydrophilic acrylic intraocular lens: biocompatibility and precision

Ladan Espandar, Shameema Sikder, Majid Moshirfar

Clinical Ophthalmology 2011, 5:65-70

Published Date: 10 January 2011

Impact of genetic polymorphisms on clinical response to antithrombotics

Kena J Lanham, Julie H Oestreich, Steven P Dunn, et al

Pharmacogenomics and Personalized Medicine 2010, 3:87-99

Published Date: 18 June 2010

Modified BODE indexes: Agreement between multidimensional prognostic systems based on oxygen uptake

José Luis Lopez-Campos, Pilar Cejudo, Eduardo Marquez, et al

International Journal of Chronic Obstructive Pulmonary Disease 2010, 5:133-140

Published Date: 4 May 2010

Potential role of stem cells in management of COPD

Tillie L Hackett, Darryl A Knight, Don D Sin

International Journal of Chronic Obstructive Pulmonary Disease 2010, 5:81-88

Published Date: 26 March 2010

Noninvasive ventilation: has Pandora’s box been opened?

Ari Manuel, Richard EK Russell, Quentin Jones

International Journal of Chronic Obstructive Pulmonary Disease 2010, 5:55-56

Published Date: 24 February 2010