PURPOSE: The purpose of the Global Initiative for Chronic Obstructive Lung Disease guidelines (GOLD) was to raise the level of awareness of COPD in physicians. It is presumed that physicians now incorporate these evidence-based guidelines into clinical practice. We reviewed the management of COPD patients (pts) at our facility before and after an educational intervention was implemented.
METHODS: Retrospective review of medical records (MR) for pts admitted with a diagnosis of COPD over a 3-month period in two consecutive years, in an urban community teaching hospital. In the interim between the two periods, a lecture series and teaching supplements were given.
RESULTS: Prior to intervention, the diagnosis was missed in 15% of the cases compared with 3% after educating physicians. Treatment with steroid, nebulizers, + oxygen was given in 100% of the cases in both periods. However, inappropriate antibiotic administration was given in 49% pre- and 24% post-intervention. Smoking history is still not consistently obtained, 15% pre- vs 18% post-intervention. Pulmonary consultations were obtained in 100% of the post-intervention period. Counseling of the patient on disease, medication use, and nutrition upon discharge were adhered to better prior to intervention.
CONCLUSION: After educational intervention, the outcomes of compliance to GOLD were as follows: (1) Recognition of the features of the disease and appropriate diagnosis was improved (2) The overuse of antibiotics still exists (3) Smoking history is still not obtained on all COPD admissions (4) Inpatient management, such as timely de-escalation of therapy is poor (5) Discharge counseling of the patient is worse when compared to pre-intervention data.
CLINICAL IMPLICATIONS: Education to physicians on the guidelines was in the form of lectures, algorithms, pocket handouts, and electronic record reminders for vaccinations. The teaching series was of value only in assisting the physician to recognize the disease and implement initial treatment. It did not seem to have an impact on inpatient management or discharge counseling. Other additional means to increase compliance need to be sought.
DISCLOSURE: Neelam Patel, No Financial Disclosure Information; No Product/Research Disclosure Information