Implementing “best practice” for COPD as outlined in guidelines from the Global Initiative for the Diagnosis and Management of Obstructive Lung Disease (GOLD) would likely have an impact in the prevention, morbidity and cost of COPD. Yet, “usual care” seldom achieves guideline care. This abstract describes successful implementation of clinical practice tools based on the GOLD interventions, and showed improved rates of guideline care.
This prospective observational cohort study implemented GOLD guidelines in a systematic fashion for 73 consecutive new COPD patients at 2 outpatient pulmonary clinics. Clinical practice tools were designed based on the GOLD interventions and integrated into a typical visit. An electronic medical record enhanced data collection, analysis and real-time feedback.
This study demonstrated improved COPD care using clinical practice tools. It achieved high rates of outcome-proven interventions for patients including immunization for pneumococcus (91%), influenza (88%), effective staging of COPD using spirometry (99%), and appropriate medications recommended for the stage of COPD (97%). It demonstrated high rates of identification of smoking status each visit (97%), provision of smoking cessation interventions (71%) and referrals to pulmonary rehabilitation (78%).
Outcome-proven interventions were achieved for COPD in the office setting by systematically implementing GOLD guidelines for COPD. These implementation protocols could be used in other outpatient settings, similar to asthma and diabetes care protocols, potentially improving delivery of care for COPD.
Clinicians could achieve GOLD guidelines during a short office visit for COPD using a simple mnemonic: “I STIR:” Identify patients at risk for COPD with spirometry, Smoking cessation counseling and intervention, Treatment appropriate for stage of COPD including correct inhaler use, Immunization for influenza and pneumococcus, and Rehabilitation referral.
L.A. Baggott, None.