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Management of Chronic Obstructive Pulmonary Disease Exacerbations Using the Global Initiative for Chronic Obstructive Lung Disease Guidelines

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Title:Management of Chronic Obstructive Pulmonary Disease Exacerbations Using the Global Initiative for Chronic Obstructive Lung Disease Guidelines
Authors:Abe, Jamie
Contributors:Daub, Katharyn (instructor)
Norris-Taylor, Joyce (instructor)
Keywords:Lungs--Diseases, Obstructive
chronic obstructive pulmonary disease
global initiative for chronic obstructive lung disease
guideline adoption
provider attitudes
show 1 morebarriers
show less
Date Issued:01 Jun 2021
Abstract:Chronic obstructive pulmonary disease (COPD) is a significant cause of morbidity and mortality
in the United States. An intermittent acute aggravation of symptoms characterizes COPD's
natural progression termed acute exacerbations of COPD (AECOPD). AECOPD is defined as a
“sustained worsening of the patient’s condition, from stable state and beyond normal day-to-day
variations, that is, acute in onset and necessitates a change in regular medication.” Greater than
80% of exacerbations are managed in the outpatient setting with pharmacological therapies that
include bronchodilators, corticosteroids, and antibiotics. Treatment variability results in adverse
health outcomes and necessitates a need to standardize care. The Global Initiative for Chronic
Obstructive Lung Disease (GOLD) guidelines were developed by worldwide experts and provide
unbiased reviews of the latest evidence to assess, diagnose, and manage COPD. The GOLD
guidelines provide evidence-based recommendations and should be integrated into practice.
Purpose: The overarching goal of this Practice Inquiry Project (PIP) was to determine the
likelihood of adopting the GOLD guidelines, which could inform practice and improve the
management of AECOPD. Methods: A qualitative, survey-based study was undertaken that
involved data collection, analysis, and a review of the literature. The PICO framework was
utilized to define the research question. Roger’s diffusion of innovation model served as the
theoretical framework used for understanding the degree of readiness or stage of change. Due to
the small sample size (n= 10), nonparametric tests were used to analyze ranked, ordinal,
dichotomous, and nominal data. The data was collected via survey and statistically analyzed to
determine the readiness to adopt and establish the current standards of care. Results: A
convenience sample of 10 providers (n=10) in the state of Hawaii completed the anonymous
survey in the form of a multiple-choice questionnaire during a 30-day period in 2021. The
questionnaires were analyzed by individual questions, and findings focused on key themes
(demographics, experience, and readiness to adopt). The results of the provider’s readiness to
adopt the GOLD standard were inconclusive. While providers acknowledged a high interest in
adopting the GOLD guidelines, their likelihood of adopting the guidelines was not likely. The
most significant barrier to adoption was Organizational/Institutional (70%, seven respondents).
Conclusion: Ultimately, adoption of the GOLD guidelines was not likely. The data identified
potential barriers to adoption and informed practice by raising awareness of the GOLD
guidelines. Further research is needed to better understand specific Organizational barriers to
adopting the GOLD guidelines.
Appears in Collections: DNP Practice Inquiry Projects

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