Guideline-based COPD management in a resource-limited setting - physicians' understanding, adherence and barriers: a cross-sectional survey of internal and family medicine hospital-based physicians in Nigeria.

BACKGROUND: Few data exist on the understanding and adherence to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines in resource-limited settings, which are mostly in sub-Saharan Africa.

OBJECTIVES: To assess physicians' understanding, adherence, and barriers to implementation of GOLD guidelines in Nigeria.

METHODS: A questionnaire based on the recommendations of the guidelines was self-administered by 156 physicians in departments of internal and family medicine in selected hospitals to assess physician understanding of the GOLD guidelines and barriers to its implementation. The medical records of patients with chronic obstructive pulmonary disease (COPD) were also reviewed to assess adherence to the guideline recommendations.

RESULTS: The performance score of all physicians was 22.37±0.39 (range 0-38). Pulmonologists had the highest score (37.00±0.00) while medical officers had the lowest score (19.93±4.98) (F=10.16, df=5, p<0.001). Forty one percent of physicians knew the spirometric criteria for diagnosing COPD and 26.9% could assess the severity. In clinical practice, 32% of patients had brief smoking counselling despite 70% being smokers, 24% had spirometry and 18% had assessment of severity. Almost 60% of patients were on oral aminophylline, 72% were on an inhaled long-acting β2-agonist and corticosteroid combination, 2% had pulmonary rehabilitation and no patients were vaccinated. Self-reported adherence to the COPD guidelines was 23.7%. Lack of familiarity (39.8%) was cited as the most common barrier to adherence to the guidelines.

CONCLUSIONS: The understanding of GOLD guidelines is satisfactory among Nigerian doctors managing patients with COPD but the level of adherence is poor. Educational interventions are needed to improve the implementation of guideline-based management.