Barriers to implementing COPD guidelines for non-medical prescribers: a qualitative interview study Alison Paterson1, Anne Kinnear1, Marion Bennie2, Moira Kinnear1,2 Caroline Souter1 1 NHS Lothian Pharmacy Services, Edinburgh, 2 University of Strathclyde, Glasgow Background Key Emergent Themes Domain (TDF) Identified barriers Skills Motivating patients to try smoking cessation or PR Beliefs about capabilities Lack of confidence in stopping ICS containing inhalers Beliefs about consequences Disengaging patients by over-mentioning smoking cessation; worsening of COPD symptoms by changing inhaled treatment Motivation and goals Conflicting priorities within the consultation Social influences Patient centred lack of motivation to engage with PR or smoking cessation; variable prescribing practices amongst the MDT; patient perception of prescriber hierarchy in the MDT Emotion Fear of negative outcomes from over-mentioning smoking cessation or changing inhaled treatment Environmental context and resources Time in consultation; limited local access to PR classes; lack of placebo inhalers In primary care chronic obstructive pulmonary disease (COPD) consultations are increasingly carried out by non-medical prescribers (NMPs) including practice nurses and pharmacist independent prescribers rather than general practitioners (GPs)1. The GOLD COPD guidelines are considered optimal practice2. Barriers to medical prescribers in implementing COPD guidelines have been established and include resource provision, difficulties in changing patient behaviours and lack of familiarity with recommendations, 3 however, there are no published studies regarding NMP-led services. Aim To identify areas of poor adherence and explore barriers to NMPs implementing the guidelines Methods Audit 23 criteria applied to 135 patient records across 3 GP practices in NHS Lothian 1:1 interviews with NMPs Semi-structured schedule based on areas of poorest adherence Practice nurses (n=4) Pharmacists (n=3) Analysis Identification and categorisation of main barriers using Theoretical Domains Framework4 Abbreviations: PR – pulmonary rehabilitation, ICS – inhaled corticosteroid, MDT – multi-disciplinary team Smoking Cessation: “If they are a happy smoker I think you have got to get the balance right, I’ve got to keep chipping away at them, but I don’t want to stop them coming back. Because all I ever go on about is smoking.” Pulmonary Rehabilitation: “So many times I have talked about it and nobody, pretty much nobody is interested.” Results Inhaler Technique: “It would be one of the things I think, and I know it’s wrong and I shouldn’t do it, one of the things that I possibly miss out on if time is getting short and I’m conscious that the next patient is sitting outside.” Audit Results – Criteria met on fewest occasions Group B treatment: “If they have been put on it in hospital it is really hard to get people off, because “the doctor said I should be on that”” Smoking cessation advice to all smokers at every visit in 9 % (n=65) 13% eligible patients are referred to pulmonary rehabilitation (n=118) 58% group B patients are not prescribed inhaled corticosteroids (n=62) Inhaler technique is checked at every review in 14% (n=129) Conclusion Barriers identified by NMPs to implementing COPD guideline were similar to those identified by medical prescribers in other studies. The major barriers to implementing evidence based pharmacological treatment included differences in prescribing practices across the multi-disciplinary team (MDT), limited experience in stopping inhaled corticosteroids when not indicated and resistance from patients. Collaboration by the MDT is required to ensure consistency in the provision of evidence based care. x References Information Services Division Scotland. Health Conditions. General Practice.  Chronic Obstructive Pulmonary Disease. Available from: http://www.isdscotland.org/Health-Topics/General-Practice/GP-consultations/Health-Conditions/COPD/. GOLD. Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2016. Available from http://goldcopd.org Sharif R, Cuevas CR, Wang Y, Arora M, Sharma G. Guideline adherence in management of stable chronic obstructive pulmonary disease. Respiratory Medicine. 2013;107(7):1046-52 Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A, et al. Making psychological theory useful for implementing evidence based practice: a consensus approach. Quality & safety in health care. 2005;14(1):26-33.