Are We Missing the Opportunity to Disseminate GOLD Recommendations Through AECOPD Discharge Letters?

Abstract

Andrea Vukić Dugac,1,2 Mirna Vergles,3 Sanda Škrinjarić Cincar,4 Ljiljana Bulat Kardum,5 Marina Lampalo,1 Sanja Popović-Grle,1,2 Jelena Ostojić,6 Tatjana Tokić Vuksan-Ćusa,7 Žarko Vrbica,8,9 Emilija Lozo Vukovac,10 Neven Tudorić11 1Clinic for Respiratory Diseases, University Hospital Centre Zagreb, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Department of Pulmonology, Clinical Hospital Dubrava, Zagreb, Croatia; 4Faculty of Medicine, University of Osijek, Osijek, Croatia; 5Department of Pulmonology, Clinical Hospital Centre Rijeka, Rijeka, Croatia; 6Pulmonary Outpatient Clinic, Special Hospital for Pulmonary Diseases, Zagreb, Croatia; 7Department of Internal Medicine, Karlovac General Hospital, Karlovac, Croatia; 8Department of Internal Medicine, Dubrovnik General Hospital, Dubrovnik, Croatia; 9University Study Programme Nursing, University of Dubrovnik, Dubrovnik, Croatia; 10Department of Pulmonology, University Hospital Split, Split, Croatia; 11Pulmonary Outpatient Clinic, St. Catherine Specialty Hospital, Zagreb, CroatiaCorrespondence: Neven Tudorić, St. Catherine Specialty Hospital, Branimirova Ul. 71E, Zagreb, 10000, Croatia, Tel [phone], Email [email protected]: Acute exacerbations in chronic obstructive pulmonary disease (AECOPD) lead to poor outcomes and increased burden for patients and healthcare systems. The Global Initiative for COPD (GOLD) includes specific recommendations for AECOPD interventions, discharge criteria, and follow-up. Aligning the AECOPD discharge letters (DL) with GOLD guidelines could facilitate dissemination of recommendations among general practitioners (GPs).Purpose: This study was conducted to assess the compliance of DL with the GOLD recommendations in Croatia.Methods: Pre-pandemic DL of patients presenting for AECOPD to emergency room (ER) were analyzed and stratified by clinical decision to hospitalize (HDL) or discharge patients for outpatient treatment (ERDL). Experienced pulmonologists checked the information from DL against guidelines by using online study-specific questionnaires.Results: In total, 225 HDL and 368 ERDL were analyzed. In most cases, the GOLD ABCD categories (85% HDL, 92% ERDL) or the spirometry-based degree of severity (90% HDL, 91% ERDL) were not included. The number of AEs in the previous year was recorded, but the specific frequent exacerbator phenotype not explicitly stated. The AE phenotype was included in two thirds of HDL and one third of ERDL. The blood eosinophil count was frequently available, but not considered decision-relevant information. Adjustments of previous maintenance therapy, mostly escalation, were recommended in 58.4% HDL and 27.9% ERDL, respectively. Education on proper use of inhalers was recommended only in 15.6% of HDL. Smoking cessation measures were advised in 23.1% HDL and 7.9% ERDL; pulmonary rehabilitation in 35.6% HDL and 0.8% ERDL. Early follow-up was frequently advised (> 50%), but rarely appointed.Conclusion: Significant deficiencies in compliance with the GOLD guidelines were identified, translating into a missed opportunity for GPs to become acquainted with GOLD recommendations. These findings emphasize the necessity to increase compliance with guidelines first at specialist level and consequent standardization of DL.Keywords: COPD, GOLD guidelines, acute exacerbation, discharge record

Keywords

• copd
• gold guidelines
• acute exacerbation
• discharge record