Level of adherence to the GOLD strategy document for management of patients admitted to hospital with an acute exacerbation of COPD

摘要

Background and 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 overprescribed. 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 nonpharmacological interventions were used rarely, suggesting a need for practice review in these areas.