Evidence-implementation gaps in low- and middle-income countries' COPD guidelines
Abstract
Introduction: While guidelines are critical for cost-effective COPD care, development and implementation in low-and middle-income countries (LMICs) is challenging. We aimed to systematically compare all available COPD guidelines worldwide and focused on global coverage and identification of critical gaps in those of LMICs. Methods: Scoping review comparing of all of the world’s national COPD management guidelines. We assessed: (1) global guideline coverage, (2) general guideline information (authors, target audience, dissemination plans), (3) content (prevention, diagnostics, treatments), (4) ethical, legal, socio-economic aspects and (5) compliance with the eight Institute of Medicine (IOM) guideline standards. LMICs were compared to high-income countries (HICs). Results: Of the 61 national COPD guidelines identified, 31 (51%) were from HICs and 30 (49%) from LMICs. Guidelines did not cover 0.02 billion people living in HICs (1.9%), whereas in LMICs 1.93 billion (30.2%) were without national guidelines. Compared with HICs, LMICs guidelines target fewer healthcare professionals and less often address case finding and comorbidities. Over 90% of guidelines included smoking cessation advice. Air pollution reduction strategies were less frequently mentioned in both LMICs (47%) and HICs (42%). HICs fulfilled on average 5.29 (66%) of IOM standards whereas LMICs guidelines fulfilled 3.37 (42%) (p<0.05). LMICs scored significantly lower compared with HICs regarding conflicts of interest management, updates, articulation of recommendations and transparency of funding (all, p<0.05). Conclusion: Local LMICs COPD guidelines are limited, should be more transparently developed and tailored to local circumstances.
Authors 15
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University Medical Center Groningen
Affiliation as printed
University Medical Center Groningen, Groningen, Netherlands
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Affiliation as printed
UCL Respiratory, University College London, London, United Kingdom
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Hospital Universitario de La Princesa · Universidad Autónoma de Madrid
Affiliation as printed
Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain
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Affiliation as printed
Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, United States of America
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Taipei Medical University-Shuang Ho Hospital · Taipei Medical University
Affiliation as printed
Division of Thoracic Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
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Grigore T. Popa University of Medicine and Pharmacy
Affiliation as printed
University of Medicine and Pharmacy ‘Grigore T. Popa’ Iasi (UMF Iasi), Iasi, Romania
University of Medicine and Pharmacy 'Grigore T. Popa' Iasi (UMF Iasi), Iasi, Romania
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Affiliation as printed
Department of Medicine, Makerere Lung Institute, Kampala, Uganda
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Universidad Peruana Cayetano Heredia
Affiliation as printed
Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
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Affiliation as printed
ARK Foundation, Dhaka, Bangladesh
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Affiliation as printed
University of Sydney, Faculty of Medicine and Health, Sydney, Australia
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Affiliation as printed
University of Sydney, Faculty of Medicine and Health, Sydney, Australia
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Affiliation as printed
Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
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University Medical Center Groningen
Affiliation as printed
University Medical Center Groningen, Groningen, Netherlands
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Niels Henrik Chavannes Aachen
Leiden University Medical Center
Affiliation as printed
Leiden University Medical Center, Leiden, Netherlands
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University Medical Center Groningen
Affiliation as printed
University Medical Center Groningen, Groningen, Netherlands
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