MANAGEMENT OF ASTHMA AND COPD PATIENTS - FEASIBILITY OF THE APPLICATION OF GUIDELINES IN GENERAL-PRACTICE

Objective. To examine the feasibility of the application of guidelines to the management of asthma and chronic obstructive pulmonary disease (COPD) by assessing compliance with the guidelines and listing the ba rriers general practitioners (GPs) encountered during implementation. Insight into the feasibility of individual items in the guidelines can guide implementation strategies in the future and, if necessary, supp ort revision of the guidelines. Design. Descriptive study of care deli vered during the implementation of guidelines by means of documentatio n of the care provided, education, feedback on compliance and peer rev iew. Setting. General practice. Study participants. Sixteen GPs in 14 general practices. Main outcome measures. Compliance was expressed as the percentage of patients per practice managed by the GPs according t o the guidelines. For each patient (n=413) data were collected on the care delivered during the first year of the implementation. Barriers e ncountered were derived from the summaries of the discussions held dur ing the monthly meetings. Results. The GPs were most compliant on the items 'PEFR measurement at every consultation' (98%),'allergy test' (7 8%) and 'advice to stop smoking' (82%), and less compliant on the item s 'four or more consultations a year' (46%),'ordering spirometry' (33% ), 'adjustment of medication' (42%), 'check on inhalation technique' ( 38%) and referral to a chest physician (17%) or a district nurse (5%). The main barriers were the amount of time to be invested, doubts abou t the necessity of regular consultations and about the indications for ordering spirometry and for referral to a chest physician or a distri ct nurse. Conclusion. Although the feasibility was assessed in a fairl y optimal situation, compliance with the guidelines was not maximal, a nd differed between the individual items of care. Suggestions are give n for further improvements in compliance with the guidelines and for r evision of the guidelines.