Implementing integrated care guidelines in asthma and COPD: It ain't easy!
Heliyon, vol. 9, pp. e21540
Abstract
Objective: To evaluate the implementation of a guideline-based, integrated, standardised, personal approach in patients with Chronic Obstructive Pulmonary Disease (COPD) or Asthma in a real-life situation. Methods: Patients at the outpatient clinic of the department of pulmonary disease were included in a controlled cohort study, comparing the use of diagnostic items and 'Personalised care plans' (PCPs) in patients with obstructive lung disease before (2013) and after (2015) implementation of a personalised diagnostic pathway. Results were compared with reference data (2016) from two control hospitals that used the same guidelines but did not implement this pathway. Results: 100 patients were selected for all three cohorts. After implementing the diagnostic pathway in 2015, 35 % of patients visited attended all pre-planned appointments, whereas 65 % of patients did not: they were diagnosed using usual care. Factors contributing to patients not attending the diagnostic care pathway were: the logistical complexity and intensity of the 2-day pathway, patients willingness to participate in a personalised pathway, and low social economic status or low literacy. After the implementation of the pathway, a significant improvement was seen in the number of PCPs (P < 0.001) and the number of diagnostic items registered recorded in the patients' electronic medical records (P < 0.001). Conclusion: Implementing a standardised diagnostic pathway in a real-life population significantly improved the number of personalised care plans, demonstrating that the implementation of holistic care planning is feasible in this population. Nevertheless, the pathway needs further improvements to maximize the number of patients benefitting from it, including logistical streamlining, removing unnecessary diagnostic tools, and increasing the focus on low literacy. Additionally, we found that implementing existing guidelines in a real life context is complex. Therefore, it is required to prioritize the translation of current guidelines into every-day practice, before expanding existing guidelines and protocols.
Authors 8
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Jan A. Witte corresponding
Affiliation as printed
Department of Pulmonary Disease, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
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Affiliation as printed
Department of Pulmonary Disease, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
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Erasmus MC · Sint Franciscus Gasthuis
Affiliation as printed
Department of Pulmonary Disease, Erasmus MC, Rotterdam, the Netherlands
Department of Pulmonary Disease, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
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Affiliation as printed
Department of Pulmonary Disease, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
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Affiliation as printed
Department of Pulmonary Disease, Catharina Ziekenhuis, Eindhoven, the Netherlands
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Leiden University Medical Center
Affiliation as printed
Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
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Affiliation as printed
Institute of Health Care Policy and Management/Institute of Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands
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Affiliation as printed
Department of Pulmonary Disease, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
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