Towards a holistic approach of patients with Asthma and COPD: implementing a diagnostic care pathway

Abstract Objective To evaluate implementation of recent guidelines in day-to-day clinical practice in patients with Obstructive Lung Disease (OLD). Methods Guidelines recommend attention for four important domains (Physiological impairments, Symptoms, Functional Limitations and Quality of life) as they give important clues for evaluation of treatment outcomes and for developing new treatments. A new diagnostic care pathway was developed to attain a holistic characterization of patients with OLD. Here, we assessed the implementation of this pathway at our outpatient clinic in secondary care in a controlled, cohort study, by comparing the diagnostic items in patients with OLD before (2013) and after (2015) implementation. Results were compared with reference data (2016) from two control hospitals. Results The diagnostic care pathway provided a significant increase in overall attention for aforementioned domains from 52% (median; IQR 44%-59%) to 81% (median; IQR 74%-85%). Especially the domains Quality of Life and Functional Limitation benefitted from the diagnostic care pathway by improving from 0–100% and 0 to 67% (median; IQR 100%-100% and 67%-83%) respectively. Approximately 65% of the patients failed to complete the 2-day assessment; they received usual care. Nonetheless, attention for the four-domain approach also improved in these patients receiving usual care (median, IQR; 52% (44–59) vs 69% (59–74). Additionally, 14% of new referrals for diagnosis and treatment of OLD did not have asthma or COPD after thorough assessment in secondary care. Conclusion The implementation of current guidelines in daily practice can achieve a culture change among healthcare professionals. However, implementing a care pathway in a real-live population proved difficult. Therefore, we should strive to successfully implement existing guidelines rather than primarily creating new guidelines, as implementation is one of the most challenging aspects of new pathways and protocols.