PURPOSE: Multiple guidelines exist for the management of COPD. One such guideline is the Global strategy for the diagnosis and management of chronic obstructive lung disease (GOLD). We asked: Does adherence to the GOLD treatment guidelines reduce health care visits for patients with COPD?.
METHODS: We reviewed the records of 1338 patients with the diagnosis of COPD (as defined by ICD-9 codes) at the Cincinnati VAMC. Patients with a concurrent diagnosis of asthma, no pulmonary function tests within the past 5 years, no health care within the past year, or who had died were excluded. The remaining 523 patients were grouped according to their FEV1 based upon the GOLD guidelines. Each patient’s medication regimen was classified as under, appropriate, or over-treatment based on the GOLD guidelines. All respiratory related office visits, emergency room visits, and hospital admissions were recorded.
RESULTS: The numbers of respiratory related office and emergency room visits were higher for the appropriately treated group compared with the under-treated group. There was no difference in respiratory related hospital admissions among the treatment groups. Over-treatment did not reduce the number of respiratory related healthcare visits when compared with under- or appropriate treatment.
CONCLUSION: Adherence to the GOLD treatment guidelines does not reduce respiratory related healthcare visits.
CLINICAL IMPLICATIONS: A prospective study is warranted to determine whether compliance with the GOLD treatment guidelines improves patient outcomes.
DISCLOSURE: Joseph Seaman, None.