Keywords: Chronic Obstructive Pulmonary Disease, Adherence, Greece

Background:

Evidence suggests that adherence to COPD guidelines is lacking in rural areas, however this issue is underreported.

Aim of the study:

Our study aimed to evaluate adherence to COPD guidelines in rural and urban primary care areas in Greece and explore opportunities for improvement.

Methodology:

This cross-sectional study was conducted in eight primary care practices in Crete, Greece with 10 GPs participating. Patients identified by GPs with COPD were included. Clinical performance vs current guidelines was categorized into levels of appropriateness: excellent (>80%), good (60–80%), adequate (40–59%), inadequate (20–39%), and very inadequate (<20%). 253 clinical records were reviewed.

Results:

Adherence to guideline statements presented an excellent/good adherence for smoking (94%), vaccination (93-96%), exacerbations (72%) and co-morbidities recording (87%) and further workup with chest X-ray or CT (71%). The most outstanding areas for improvement included evaluating COPD risk factors beyond smoking (14%), measuring alpha1-antitrypsin levels (2%), monitoring treatment adherence (12%), referring patients to pulmonary rehabilitation (8%), considering eosinophil counts for treatment initiation (10%), developing written self-management plans (10%), and assessing non-prescribed medications (19%). Guideline adherence varied substantially between rural and urban settings across several key areas: symptom assessment (33 vs 12%), smoking (90 vs 97%) and other risk factor assessment (23 vs 8%), COPD classification (44 vs 30%), DTP/DTaP (22 vs 78%) and VZV (29 vs 75%) vaccination records, initial treatment selection criteria, specifically ABE classification (64 vs 45%) and eosinophils count (21 vs 3%), patient self-management plans (23 vs 2%), inhalation technique (20 vs 6%), treatment adherence (23 vs 5%), use of TAI (10 vs 1%), cognitive function assessment (24 vs 39%), and pulmonary rehabilitation referrals (13 vs 5%).

Conclusions:

In conclusion, our results show that adherence to COPD guidelines among GPs is suboptimal and varies between rural and urban settings. Health care professionals and administrators in primary care could utilize targeted strategies to improve clinical practice.