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Published in: Clinical and Translational Medicine 1/2012

Open Access 01-12-2012 | Research

A short-term educational program improved physicians’ adherence to guidelines for COPD and asthma in Shanghai

Authors: Xiaocong Fang, Shanqun Li, Lei Gao, Naiqing Zhao, Xiangdong Wang, Chunxue Bai

Published in: Clinical and Translational Medicine | Issue 1/2012

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Abstract

Background

Chronic pulmonary diseases such as chronic obstructive pulmonary disease (COPD) and asthma exert increasing burden on society while the management of them is far from adequate. The objective of this study is to evaluate adherence to guidelines through a patient study, and then investigate the effects of a short-term quality improvement educational program among clinicians in Shanghai, China.

Methods

A prescription survey was performed in a random sample of 100 COPD and asthma outpatients to assess their pharmacological therapy. Then, an educational program was conducted in young pulmonary physicians from 83 hospitals in Shanghai. The training course was divided into 7 sessions of 2 hours delivered over 4 days from July 2010 to August 2011. Three months later, all of the participants were asked to take a written examination to assess the efficiency of training.

Results

Prescription survey among the patients indicated the prescriptions are not consistent with the recommendations of current GOLD and GINA guidelines. The mainly existing issue is the overuse of inhaled glucocorticosteroid. For the educational program, 161 pulmonary physicians have attended the training course, and 110 clinicians finished the tests with an attendance rate of 68.3%. Although most of the clinicians recognized the increasing burden of COPD and asthma, they do not know well about the core elements of guidelines and their clinical practice is not fully in agreement with current recommendations. Through crossover comparison, our results suggested clinicians’ knowledge of the guidelines was improved after training.

Conclusions

We concluded that application of continuous educational programs among physicians might promote their adherence to guidelines, and by that improve the quality of healthcare.
Appendix
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Literature
1.
go back to reference Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, van Weel C, Zielinski J: Global Initiative for Chronic Obstructive Lung Disease: Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease - GOLD executive summary. Am J Respir Crit Care Med 2007, 176: 532–535.CrossRefPubMed Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, van Weel C, Zielinski J: Global Initiative for Chronic Obstructive Lung Disease: Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease - GOLD executive summary. Am J Respir Crit Care Med 2007, 176: 532–535.CrossRefPubMed
2.
go back to reference Bateman ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, FitzGerald M, Gibson P, Ohta K, O’Byrne P, Pedersen SE, Pizzichini E, Sullivan SD, Wenzel SE, Zar HJ: Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J 2008, 31: 143–178.CrossRefPubMed Bateman ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, FitzGerald M, Gibson P, Ohta K, O’Byrne P, Pedersen SE, Pizzichini E, Sullivan SD, Wenzel SE, Zar HJ: Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J 2008, 31: 143–178.CrossRefPubMed
3.
go back to reference Bahadori K, Doyle-Waters MM, Marra C, Lynd L, Alasaly K, Swiston J, FitzGerald JM: Economic burden of asthma: a systematic review. BMC Pulm Med 2009, 19: 24.CrossRef Bahadori K, Doyle-Waters MM, Marra C, Lynd L, Alasaly K, Swiston J, FitzGerald JM: Economic burden of asthma: a systematic review. BMC Pulm Med 2009, 19: 24.CrossRef
5.
go back to reference Halbert RJ, Natoli JL, Gano A, Badamgarav E, Buist AS, Mannino DM: Global burden of COPD: systematic review and meta-analysis. Eur Respir J 2006, 28: 523–532.CrossRefPubMed Halbert RJ, Natoli JL, Gano A, Badamgarav E, Buist AS, Mannino DM: Global burden of COPD: systematic review and meta-analysis. Eur Respir J 2006, 28: 523–532.CrossRefPubMed
6.
go back to reference Masoli M, Fabian D, Holt S, Beasley R: Global Initiative for Asthma (GINA) Program: the global burden of asthma: executive summary of the GINA dissemination committee report. Allergy 2004, 59: 469–478.CrossRefPubMed Masoli M, Fabian D, Holt S, Beasley R: Global Initiative for Asthma (GINA) Program: the global burden of asthma: executive summary of the GINA dissemination committee report. Allergy 2004, 59: 469–478.CrossRefPubMed
7.
go back to reference Chu LA, Bratzler DW, Lewis RJ, Murray C, Moore L, Shook C, Weingarten SR: Improving the quality of care for patients with pneumonia in very small hospitals. Arch Intern Med 2003, 163: 326–332.CrossRefPubMed Chu LA, Bratzler DW, Lewis RJ, Murray C, Moore L, Shook C, Weingarten SR: Improving the quality of care for patients with pneumonia in very small hospitals. Arch Intern Med 2003, 163: 326–332.CrossRefPubMed
8.
go back to reference Fang XC, Wang XD, Bai CX: COPD in China: the burden and importance of proper management. Chest 2011, 139: 820–829. Fang XC, Wang XD, Bai CX: COPD in China: the burden and importance of proper management. Chest 2011, 139: 820–829.
9.
go back to reference Zhong N, Wang C, Yao W, Chen P, Kang J, Huang S, Chen B, Wang C, Ni D, Zhou Y, Liu S, Wang X, Wang D, Lu J, Zheng J, Ran P: Prevalence of chronic obstructive pulmonary disease in China-A large, population-based survey. Am J Respir Crit Care Med 2007, 176: 753–760.CrossRefPubMed Zhong N, Wang C, Yao W, Chen P, Kang J, Huang S, Chen B, Wang C, Ni D, Zhou Y, Liu S, Wang X, Wang D, Lu J, Zheng J, Ran P: Prevalence of chronic obstructive pulmonary disease in China-A large, population-based survey. Am J Respir Crit Care Med 2007, 176: 753–760.CrossRefPubMed
10.
go back to reference Heffner JE, Ellis R: The guideline approach to chronic obstructive pulmonary disease: how effective? Respir Care 2003, 48: 1257–1266.PubMed Heffner JE, Ellis R: The guideline approach to chronic obstructive pulmonary disease: how effective? Respir Care 2003, 48: 1257–1266.PubMed
11.
go back to reference Myers TR: Guidelines for asthma management: a review and comparison of 5 current guidelines. Respir Care 2008, 53: 751–767.PubMed Myers TR: Guidelines for asthma management: a review and comparison of 5 current guidelines. Respir Care 2008, 53: 751–767.PubMed
12.
go back to reference Rutschmann OT, Janssens JP, Vermeulen B, Sarasin FP: Knowledge of guidelines for the management of COPD: a survey of primary care physicians. Respir Med 2004, 98: 932–937.CrossRefPubMed Rutschmann OT, Janssens JP, Vermeulen B, Sarasin FP: Knowledge of guidelines for the management of COPD: a survey of primary care physicians. Respir Med 2004, 98: 932–937.CrossRefPubMed
13.
go back to reference Tsagaraki V, Markantonis SL, Amfilochiou A: Pharmacotherapeutic management of COPD patients in Greece – adherence to international guidelines. J Clin Pharm Ther 2006, 31: 369–374.CrossRefPubMed Tsagaraki V, Markantonis SL, Amfilochiou A: Pharmacotherapeutic management of COPD patients in Greece – adherence to international guidelines. J Clin Pharm Ther 2006, 31: 369–374.CrossRefPubMed
14.
go back to reference Zainudin BM, Lai CK, Soriano JB, Jia-Horng W, De Guia TS: Asthma Insights and Reality in Asia-Pacific (AIRIAP) Steering Committee: Asthma control in adults in Asia-Pacific. Respirology 2005, 10: 579–586.CrossRefPubMed Zainudin BM, Lai CK, Soriano JB, Jia-Horng W, De Guia TS: Asthma Insights and Reality in Asia-Pacific (AIRIAP) Steering Committee: Asthma control in adults in Asia-Pacific. Respirology 2005, 10: 579–586.CrossRefPubMed
15.
go back to reference Phanareth K, Hansen LS, Christensen LK, Laursen LC, Hansen EF: Treatment of acute severe asthma and chronic obstructive pulmonary disease in Danish hospitals. Do national recommendations improve on the quality of the treatment? Respir Med 2002, 96: 653–658.CrossRefPubMed Phanareth K, Hansen LS, Christensen LK, Laursen LC, Hansen EF: Treatment of acute severe asthma and chronic obstructive pulmonary disease in Danish hospitals. Do national recommendations improve on the quality of the treatment? Respir Med 2002, 96: 653–658.CrossRefPubMed
16.
go back to reference Trakada G, Spiropoulos K: Chronic obstructive pulmonary disease management among primary healthcare physicians. Monaldi Arch Chest Dis 2000, 55: 201–214.PubMed Trakada G, Spiropoulos K: Chronic obstructive pulmonary disease management among primary healthcare physicians. Monaldi Arch Chest Dis 2000, 55: 201–214.PubMed
17.
go back to reference Chavez PC, Shokar NK: Diagnosis and management of chronic obstructive pulmonary disease (COPD) in a primary care clinic. COPD 2009, 6: 446–451.CrossRefPubMed Chavez PC, Shokar NK: Diagnosis and management of chronic obstructive pulmonary disease (COPD) in a primary care clinic. COPD 2009, 6: 446–451.CrossRefPubMed
18.
go back to reference Jones RC, Dickson-Spillmann M, Mather MJ, Marks D, Shackell BS: Accuracy of diagnostic registers and management of chronic obstructive pulmonary disease: the Devon primary care audit. Respir Res 2008, 9: 62.PubMedCentralCrossRefPubMed Jones RC, Dickson-Spillmann M, Mather MJ, Marks D, Shackell BS: Accuracy of diagnostic registers and management of chronic obstructive pulmonary disease: the Devon primary care audit. Respir Res 2008, 9: 62.PubMedCentralCrossRefPubMed
19.
go back to reference Vermeire PA, Rabe KF, Soriano JB, Maier WC: Asthma control and differences in management practices across seven European countries. Respir Med 2002, 96: 142–149.CrossRefPubMed Vermeire PA, Rabe KF, Soriano JB, Maier WC: Asthma control and differences in management practices across seven European countries. Respir Med 2002, 96: 142–149.CrossRefPubMed
20.
go back to reference Davis D, Bordage G, Moores LK, Bennett N, Marinopoulos SS, Mazmanian PE, Dorman T, McCrory D, American College of Chest Physicians Health and Science Policy Committee: The science of continuing medical education: terms, tools, and gaps: effectiveness of continuing medical education: American College of Chest Physicians Evidence- Based Educational Guidelines. Chest 2009, 135(Suppl 3):8–16.CrossRef Davis D, Bordage G, Moores LK, Bennett N, Marinopoulos SS, Mazmanian PE, Dorman T, McCrory D, American College of Chest Physicians Health and Science Policy Committee: The science of continuing medical education: terms, tools, and gaps: effectiveness of continuing medical education: American College of Chest Physicians Evidence- Based Educational Guidelines. Chest 2009, 135(Suppl 3):8–16.CrossRef
21.
go back to reference Karen MO, Kristi EE, Robert FO, Jacqueline NP, Floyd CP, Jane R: Educational interventions and outcomes-a literature review of CME regarding Institute of Medicine (IOM) competencies. CE Meas 2006, 1: 17–26. Karen MO, Kristi EE, Robert FO, Jacqueline NP, Floyd CP, Jane R: Educational interventions and outcomes-a literature review of CME regarding Institute of Medicine (IOM) competencies. CE Meas 2006, 1: 17–26.
22.
go back to reference Ulrik CS, Hansen EF, Jensen MS, Rasmussen FV, Dollerup J, Hansen G, Andersen KK, KVASIMODO II study group: Management of COPD in general practice in Denmark–participating in an educational program substantially improves adherence to guidelines. Int J Chron Obstruct Pulmon Dis 2010, 5: 73–79.PubMedCentralCrossRefPubMed Ulrik CS, Hansen EF, Jensen MS, Rasmussen FV, Dollerup J, Hansen G, Andersen KK, KVASIMODO II study group: Management of COPD in general practice in Denmark–participating in an educational program substantially improves adherence to guidelines. Int J Chron Obstruct Pulmon Dis 2010, 5: 73–79.PubMedCentralCrossRefPubMed
23.
go back to reference Lange P, Rasmussen FV, Borgeskov H, Dollerup J, Jensen MS, Roslind K, Nielsen LM, KVASIMODO Study Group: The quality of COPD care in general practice in Denmark: the KVASIMODO study. Prim Care Respir J 2007, 16: 174–181.CrossRefPubMed Lange P, Rasmussen FV, Borgeskov H, Dollerup J, Jensen MS, Roslind K, Nielsen LM, KVASIMODO Study Group: The quality of COPD care in general practice in Denmark: the KVASIMODO study. Prim Care Respir J 2007, 16: 174–181.CrossRefPubMed
24.
go back to reference Drexel C, Jacobson A, Hanania NA, Whitfield B, Katz J, Sullivan T: Measuring the impact of a live, case-based, multiformat, interactive continuing medical education program on improving clinician knowledge and competency in evidence-based COPD care. Int J Chron Obstruct Pulmon Dis 2011, 6: 297–307.PubMedCentralPubMed Drexel C, Jacobson A, Hanania NA, Whitfield B, Katz J, Sullivan T: Measuring the impact of a live, case-based, multiformat, interactive continuing medical education program on improving clinician knowledge and competency in evidence-based COPD care. Int J Chron Obstruct Pulmon Dis 2011, 6: 297–307.PubMedCentralPubMed
25.
go back to reference Brown R, Bratton SL, Cabana MD, Kaciroti N, Clark NM: Physician asthma education program improves outcomes for children of low-income families. Chest 2004, 126: 369–374.CrossRefPubMed Brown R, Bratton SL, Cabana MD, Kaciroti N, Clark NM: Physician asthma education program improves outcomes for children of low-income families. Chest 2004, 126: 369–374.CrossRefPubMed
26.
go back to reference Cabana MD, Slish KK, Evans D, Mellins RB, Brown RW, Lin X, Kaciroti N, Clark NM: Impact of physician asthma care education on patient outcomes. Pediatrics 2006, 117: 2149–2157.CrossRefPubMed Cabana MD, Slish KK, Evans D, Mellins RB, Brown RW, Lin X, Kaciroti N, Clark NM: Impact of physician asthma care education on patient outcomes. Pediatrics 2006, 117: 2149–2157.CrossRefPubMed
27.
go back to reference Ma R, Cheng QJ, Yao D, Tao M, Ni JH, Zhou M, Wan HY, Huang SG: Epidemiological Survey of Chronic Obstructive Pulmonary Disease in the Elders in Shanghai. Acad J Shanghai Second Med Univ 2005, 25: 521–524. Ma R, Cheng QJ, Yao D, Tao M, Ni JH, Zhou M, Wan HY, Huang SG: Epidemiological Survey of Chronic Obstructive Pulmonary Disease in the Elders in Shanghai. Acad J Shanghai Second Med Univ 2005, 25: 521–524.
29.
go back to reference Qian JJ, Ma JY, Zhou M, Zhou X: A survey on epidemiology and risk factors of bronchial asthma in Baoshan district of Shanghai. Journal of internal medicine concepts & practice 2011, 06(2):121–124. Qian JJ, Ma JY, Zhou M, Zhou X: A survey on epidemiology and risk factors of bronchial asthma in Baoshan district of Shanghai. Journal of internal medicine concepts & practice 2011, 06(2):121–124.
31.
go back to reference Barnes PJ: Inhaled corticosteroids are not beneficial in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2000, 161: 342–344.CrossRefPubMed Barnes PJ: Inhaled corticosteroids are not beneficial in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2000, 161: 342–344.CrossRefPubMed
34.
go back to reference Lai CK, De Guia TS, Kim YY, Kuo SH, Mukhopadhyay A, Soriano JB, Trung PL, Zhong NS, Zainudin N, Zainudin BM, Asthma Insights and Reality in Asia-Pacific Steering Committee: Asthma control in the Asia-Pacific region: the Asthma Insights and Reality in Asia-Pacific Study. J Allergy Clin Immunol 2003, 111: 263–268.CrossRefPubMed Lai CK, De Guia TS, Kim YY, Kuo SH, Mukhopadhyay A, Soriano JB, Trung PL, Zhong NS, Zainudin N, Zainudin BM, Asthma Insights and Reality in Asia-Pacific Steering Committee: Asthma control in the Asia-Pacific region: the Asthma Insights and Reality in Asia-Pacific Study. J Allergy Clin Immunol 2003, 111: 263–268.CrossRefPubMed
35.
go back to reference Yuzhi C, National cooperation group on childhood asthma, China: Comparative analysis of the state of asthma prevalence in children from two nation-wide surveys in 1990 and 2000 year. Zhonghua Jiehe He Huxi Zazhi 2004, 27: 112–116. Yuzhi C, National cooperation group on childhood asthma, China: Comparative analysis of the state of asthma prevalence in children from two nation-wide surveys in 1990 and 2000 year. Zhonghua Jiehe He Huxi Zazhi 2004, 27: 112–116.
36.
go back to reference Zhang HQ, Li YQ, Qin H: Survey on diagnosis and treatment of chronic obstructive pulmonary disease in physicians working in local hospitals in Shanghai[in Chinese]. Shanghai Med J 2008, 31: 806–811. Zhang HQ, Li YQ, Qin H: Survey on diagnosis and treatment of chronic obstructive pulmonary disease in physicians working in local hospitals in Shanghai[in Chinese]. Shanghai Med J 2008, 31: 806–811.
37.
go back to reference He QY, Zhou X, Xie CM: Knowledge level about prevention and treatment of COPD: a cross-sectional survey in pulmonary physicians. Chin J Respir Crit Care Med 2009, 8: 117–121. He QY, Zhou X, Xie CM: Knowledge level about prevention and treatment of COPD: a cross-sectional survey in pulmonary physicians. Chin J Respir Crit Care Med 2009, 8: 117–121.
38.
go back to reference Wan HY, Tang W, Huang SG, Deng WW: Asthma questionnaire survey among the physicians of respiratory medicine in Shanghai area[in Chinese]. Shanghai Med J 2005, 28: 996–999. Wan HY, Tang W, Huang SG, Deng WW: Asthma questionnaire survey among the physicians of respiratory medicine in Shanghai area[in Chinese]. Shanghai Med J 2005, 28: 996–999.
39.
go back to reference Shen N, Yao W, Zhu H: Patient’s perspective of chronic obstructive pulmonary disease in Yanqing County of Beijing. Chin J Tuberc Respir Dis 2008, 31: 206–208. Shen N, Yao W, Zhu H: Patient’s perspective of chronic obstructive pulmonary disease in Yanqing County of Beijing. Chin J Tuberc Respir Dis 2008, 31: 206–208.
40.
go back to reference Xie GQ, Cheng XS, Xu XS, et al.: Effects of comprehensive interventions in community on smoking, chronic bronchitis, and asthma in rural areas of Beijing [in Chinese]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2005, 27: 92–98.PubMed Xie GQ, Cheng XS, Xu XS, et al.: Effects of comprehensive interventions in community on smoking, chronic bronchitis, and asthma in rural areas of Beijing [in Chinese]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2005, 27: 92–98.PubMed
41.
go back to reference Chiang YC, Lee CN, Lin YM: Impact of a continuing education program on pharmacists’ knowledge and attitudes toward asthma patient care [in Chinese]. Med Princ Pract 2010, 19: 305–311.CrossRefPubMed Chiang YC, Lee CN, Lin YM: Impact of a continuing education program on pharmacists’ knowledge and attitudes toward asthma patient care [in Chinese]. Med Princ Pract 2010, 19: 305–311.CrossRefPubMed
42.
go back to reference He Q, Zhao Q: Spirometry utilization for COPD in several provinces in China. Chin J Tuberc Respir Dis 2003, 26: 39–40. He Q, Zhao Q: Spirometry utilization for COPD in several provinces in China. Chin J Tuberc Respir Dis 2003, 26: 39–40.
43.
go back to reference Xu F, Yin XY, Zhang M, Shen H, Lu L, Xu Y: Prevalence of physician-diagnosed COPD and its association with smok- ing among urban and rural residents in regional mainland China. Chest 2005, 128: 2818–2823.CrossRefPubMed Xu F, Yin XY, Zhang M, Shen H, Lu L, Xu Y: Prevalence of physician-diagnosed COPD and its association with smok- ing among urban and rural residents in regional mainland China. Chest 2005, 128: 2818–2823.CrossRefPubMed
44.
go back to reference Zhang HQ, Li YQ, Qin H: Survey on diagnosis and treatment of chronic obstructive pulmonary disease in physicians working in local hospitals in Shanghai. Shanghai Med J 2008, 31: 806–811. Zhang HQ, Li YQ, Qin H: Survey on diagnosis and treatment of chronic obstructive pulmonary disease in physicians working in local hospitals in Shanghai. Shanghai Med J 2008, 31: 806–811.
45.
go back to reference Kang MK, Kim BK, Kim TW, Kim SH, Kang HR, Park HW, Chang YS, Kim SS, Min KU, Kim YY, Cho SH: Physicians’ preferences for asthma guidelines implementation. Allergy Asthma Immunol Res 2010, 2: 247–253.PubMedCentralCrossRefPubMed Kang MK, Kim BK, Kim TW, Kim SH, Kang HR, Park HW, Chang YS, Kim SS, Min KU, Kim YY, Cho SH: Physicians’ preferences for asthma guidelines implementation. Allergy Asthma Immunol Res 2010, 2: 247–253.PubMedCentralCrossRefPubMed
Metadata
Title
A short-term educational program improved physicians’ adherence to guidelines for COPD and asthma in Shanghai
Authors
Xiaocong Fang
Shanqun Li
Lei Gao
Naiqing Zhao
Xiangdong Wang
Chunxue Bai
Publication date
01-12-2012
Publisher
Springer Berlin Heidelberg
Published in
Clinical and Translational Medicine / Issue 1/2012
Electronic ISSN: 2001-1326
DOI
https://doi.org/10.1186/2001-1326-1-13

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