Background:
The adoption of clinical practice guideline recommendations for
COPD is suboptimal. Determining the barriers to the implementation
of these practice guidelines may help improve patient care.
Objective: To determine whether barriers to the use of pharmacotherapy
according to practice guidelines are related primarily to patient
or prescriber factors.
Methods: Retrospective cohort study. Members of a health maintenance
organization identified as having spirometry-defined COPD ranging
from stage II to IV. Electronic medical records were reviewed
for documentation of the following: 1) patient affordability issues,
2) history of an adverse drug reaction, 3) history of inefficacy
to therapy, and 4) prescription history.
Results: A total of 111 medical records were reviewed. There were
51% of patients who had not filled medications that had been prescribed
in accordance with guidelines and 43% did not have the guideline
recommended medications prescribed in the previous year. Only
4% and 2% of patients had documented inefficacy and affordability
issues, respectively. There were no reported cases of adverse
drug reactions.
Conclusions: This study provides insight to the acceptance of
COPD treatment recommendations by patients and providers. Further
research is needed to design interventions to reduce barriers
and optimize COPD treatment.
Keywords:
Pulmonary Disease,
Chronic Obstructive. Practice Guidelines. Drug Therapy. Patient
Compliance. United States.
