Evidence map›Paper›PMID 38027862›Full record

ArticleHeliyon2023

Implementing integrated care guidelines in asthma and COPD: It ain't easy!

Jan A Witte, Erwin Birnie, Gert-Jan Braunstahl, Edmée van den Akker, Walter J M van Litsenburg, Niels H Chavannes, Maureen P M H Rutten-van Mölken, Johannes C C M In 't Veen

Abstract read
In one paragraph

Article in Heliyon, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Jan A WitteDepartment of Pulmonary Disease, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands.
Erwin BirnieDepartment of Pulmonary Disease, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands.
Gert-Jan BraunstahlDepartment of Pulmonary Disease, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands.
Edmée van den AkkerDepartment of Pulmonary Disease, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands.
Walter J M van LitsenburgDepartment of Pulmonary Disease, Catharina Ziekenhuis, Eindhoven, the Netherlands.
Niels H ChavannesDepartment of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.
Maureen P M H Rutten-van MölkenInstitute of Health Care Policy and Management/Institute of Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands.
Johannes C C M In 't VeenDepartment of Pulmonary Disease, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

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.

Identifiers

PMID38027862
PMCPMC10651497

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.