Topic Suggestion
1. What is the decision or change you are facing or struggling with where a summary of the evidence would be helpful?
[redacted nominator organization] has an interest in better understanding prescribing and treatment patterns in patients with chronic obstructive pulmonary disease (COPD). Specifically, how current practice does or does not align with the 2019 clinical recommendations issued by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and further, the impact on patient outcomes.
2. Why are you struggling with this issue?
Despite efforts to improve implementation, it remains unclear if current practice in the United States follows and aligns with established treatment recommendations such as the GOLD recommendations (Sharif 2013). Several studies have shown that adherence to GOLD standards in clinical practice is low, particularly in the primary care setting (Overington 2014), and that substantial barriers to adoption exist (eg, low familiarity and time constraints) (Perez 2012, Salinas 2011). Additionally, Surani et al. present data that suggest treatment patterns are not being prescribed according to GOLD. We would like to understand the evidence base comprehensively to determine whether adherence to GOLD recommendations is or is not associated with better patient outcomes (Surani 2019).
Importantly, it will be necessary to incorporate real-world evidence (RWE) as randomized controlled trials (RCTs) are not likely to be sufficient to address this research topic. Within the respiratory therapeutic area specifically, RWE provides an understanding of the effectiveness of interventions and treatment outcomes (Price 2015), without any trial design influence. RWE is already being used in European healthcare systems to support access to new or emerging medications (GetReal 2019) and is becoming increasingly leveraged by US-based regulators to inform the use of new treatments in actual practice (Gottlieb 2018).
3. What do you want to see changed? How will you know that your issue is improving or has been addressed?
An evidence report on this proposed topic will help the COPD community understand the extent to which guidelines are adhered to and their potential association with improvement in patient outcomes for those living with COPD. As a result, it is our intent to raise awareness among providers, both primary and pulmonologists, of the importance and benefit of optimizing evidence-based treatment strategies that are associated with positive outcomes such as decreased exacerbations of COPD, reduced hospitalizations or re-admissions, reduction in pneumonias, fewer expenditures, etc. It is also important to understand if the evidence reveals any practices and/or prescribing patterns that may benefit patients but are not otherwise described in current recommendations. This would provide an evidence base to inform updates to the treatment recommendations.
4. When do you need the evidence report?
Fri, 12/31/2021
5. What will you do with the evidence report?
The resulting AHRQ evidence report will provide healthcare providers a more comprehensive picture from a reputable source of the uptake of GOLD recommendations in the US and the associated impact of these treatment patterns on patients living with COPD.
Citations
Available in the attached PDF (52 KB).
