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














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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.



Lungs--Diseases, Obstructive, chronic obstructive pulmonary disease, global initiative for chronic obstructive lung disease, guideline adoption, provider attitudes, barriers





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