Adherence to the Chronic Obstructive Pulmonary Disease guidelines in primary care: The Greek COPD COCARE study

Purpose

Although adherence to COPD guidelines among general practitioners (GPs) is essential for providing effective patient care, research indicates significant variation in their implementation. We aimed to evaluate adherence to COPD guidelines in primary care in Greece and explore opportunities for improvement.

Methods

This cross-sectional study was conducted in eight primary care practices in Crete, Greece with 10 GPs participating. Patients identified by GPs with COPD diagnosis were included. Clinical performance vs current guidelines was categorized into levels of appropriateness: excellent (>80 %), good (60–80 %), adequate (40–59 %), inadequate (20–39 %), and very inadequate (<20 %).

Results

253 clinical records were reviewed. Adherence to guideline statements presented an excellent/good adherence for smoking (94 %), vaccination (93–96 %), exacerbations (72 %) and co-morbidities recording (87 %) and further workup with chest X-ray or CT (71 %). However, guideline-concordant prescriptions for inhaled therapies were documented in only 34 % of the patient population. The most outstanding areas for improvement included evaluating COPD risk factors beyond smoking (14 %), measuring alpha1-antitrypsin levels (2 %), monitoring treatment adherence (12 %), referring patients to pulmonary rehabilitation (8 %), considering eosinophil counts for treatment initiation (10 %), developing written self-management plans (10 %), and assessing non-prescribed medications (19 %). Guideline adherence varied substantially between rural and urban settings across several key areas.

Conclusion

Our results show that adherence to COPD guidelines among GPs is suboptimal and varies between rural and urban settings. Such information must be accounted for by health care professionals and administrators in primary care, to improve strategies and establish better clinical practices.