CHEST Guidelines-Assessment-of-Intervention-Fidelity-and-Recommenda (1)

Assessment-of-Intervention-Fidelity-and-Recommenda (1)

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The document is a systematic review conducted by the CHEST Expert Cough Panel, focusing on intervention fidelity in studies assessing the diagnosis and management of chronic cough in adults. Published in the journal CHEST in July 2015, it addresses the variability in successful management outcomes reported in literature related to adherence to diagnostic and therapeutic interventions—termed intervention fidelity.<br /><br />The systematic review spanned literature from January 1998 to May 2014, assessing 23 studies that involved 3,636 patients. These studies varied in design, including prospective observational, randomized controlled, and retrospective studies. The review identified deficiencies in intervention fidelity as a key reason for variability in treatment outcomes, noting that adherence to guidelines was often not documented or applied consistently.<br /><br />The review assessed five main areas of intervention fidelity: study design, provider training, treatment delivery, receipt of treatment, and enactment of treatment, assigning an average fidelity score that was poor across the board. Most studies failed to address patient-provider concordance in understanding treatment and measuring adherence to treatment protocols.<br /><br />The findings indicated that diagnosing chronic cough often did not align with the latest guidelines, particularly regarding gastroesophageal reflux disease (GERD) management. These inconsistencies highlighted issues with study designs not fully implementing or conveying adherence to clinical practice guidelines. As a result, the review concluded that low-quality evidence supports current intervention fidelity efforts, stressing that increased attention to fidelity could improve research quality and outcomes validity.<br /><br />Recommendations include incorporating intervention fidelity in study designs and employing standardized training, delivery, receipt, and enactment plans. The importance of using evidence-based guidelines in chronic cough studies was stressed to enhance diagnosis accuracy and treatment efficacy, thereby ultimately improving patient outcomes and the development of reliable clinical guidelines.

Keywords

intervention fidelity

chronic cough

systematic review

adherence

diagnosis

treatment outcomes

clinical guidelines

GERD management

CHEST Expert Cough Panel

evidence-based