VANCOUVER, B.C.– A live, interactive, cased-based educational initiative improved primary care physicians’ knowledge of chronic obstructive pulmonary disease, according to study results reported at the annual meeting of the American College of Chest Physicians.
Dr. Nicola A. Hanania
In a cross-sectional study of 50 primary care physicians who participated in the initiative and 50 similar nonparticipants, the former were more likely to know that alveolar destruction is a pathophysiologic feature of COPD (94% vs. 74%) and that women have greater susceptibility to the harmful effects of smoking (90% vs. 54%), according to Dr. Nicola A. Hanania and his coinvestigators.
Additionally, when presented with case vignettes, the participants were more likely to recognize the presence of COPD in dyspnea patients (90% vs. 74%).
"Even though this was sort of a one-time ... cross-sectional survey, we believe that educational initiatives such as this one may at least improve the knowledge about COPD – both diagnosis and management," commented Dr. Hanania, an associate professor of medicine at Baylor College of Medicine, Houston.
Explaining the need for primary care–focused efforts, he noted that "the majority of COPD patients are [seen] in the primary care arena."
But statistics show that "COPD remains under-recognized and underdiagnosed in about 50% of the population out there, not only in the United States but in other countries as well. It also remains undertreated," even though the GOLD (Global Initiative for Chronic Obstructive Lung Disease) guidelines now stress that it is a treatable disease.
The initiative studied – called Improving COPD Patient Outcomes: Breaking Down the Barriers to Optimal Care – was designed to improve primary care providers’ knowledge and competency in the guideline-based diagnosis, staging, and management of COPD, Dr. Hanania said.
It consisted of a series of live half-day meetings conducted over a 3-month period that included short lectures, a video on correct use of inhaler devices, and small-group workshops that incorporated detailed case discussions and hands-on demonstrations and practice in the use of spirometry.
A total of 769 physicians attended the meetings. The investigators assessed the initiative’s effectiveness with a case vignette–based survey, given to a randomly selected subset of 50 participants and 50 nonparticipants with similar demographics and practice characteristics.
The number of patients with COPD seen weekly was 11 for participants and 15 for nonparticipants. The mean number of years in practice was 28 and 24, respectively. And both groups were about equally divided between family physicians and internal medicine physicians. Participants were somewhat more likely to be in solo practice (45% vs. 38%) or work in a government facility (25% vs. 0%), and less likely to be in group practice (31% vs. 58%).
Survey results showed that in the area of diagnosis, the participants were more likely than the nonparticipants to recognize COPD in case vignettes of patients with dyspnea (90% vs. 74%, P = .007) and to be aware of the greater susceptibility of women compared with men to the harmful effects of smoking (90% vs. 54%, P less than .001).
Also, when asked which of several pathophysiologic features was one of COPD, participants were more likely to correctly answer alveolar destruction (94% vs. 74%, P = .007). (The other options were muscular deconditioning, synovial inflammation, and increased ventricular filling pressure.)
While the groups did not differ significantly in terms of how likely they were to use spirometry for diagnosis and staging of COPD, participants were more likely than nonparticipants to indicate that difficulty in obtaining spirometry results in the office setting was a very significant barrier to COPD management (27% vs. 12%). "Maybe they acknowledged that it is an important tool, but they cannot do it," he commented.
The groups were statistically indistinguishable with respect to their approaches to caring for patients with repeated exacerbations and improving adherence, and their selection of appropriate maintenance therapy.
The survey also asked about barriers to managing COPD, which may help in designing future initiatives, Dr. Hanania said.
In addition to difficulty with spirometry, the groups were similarly likely to rate as very significant a patient’s nonadherence to a recommendation to stop smoking, the complexity of the medical regimen, and a lack of clarity about the staging of COPD severity.
A calculation of the initiative’s quality of education index showed that participants were 50% more likely than nonparticipants to provide evidence-based, guideline-driven COPD care, Dr. Hanania reported. "We estimate that participation in this half-day program can potentially improve the care of many patients per week, but this needs to be further tested," he commented.
"We did not attempt to look at long-term [outcomes] – retention of knowledge or practice change – which are very important," Dr. Hanania acknowledged. But a similar, ongoing initiative, being conducted by the ACCP, is currently assessing impact on real-life practice.