Integrating COPD Services Results in Improved Patient Care Delivery, Study Finds

The implementation of the Chronic Obstructive Pulmonary Disease Coordinated Access to Reduce Exacerbations (COPD CARE) package was found to improve physician confidence when incorporating evidence-based interventions and team-based approaches into routine clinical care when treating a patient with chronic obstructive pulmonary disease (COPD), a study finds.

COPD CARE, a bundled service, includes the integration of a clinical pharmacist practitioner, registered nurse, and primary care provider working together to optimize medications, inhaler technique, exercise, emoking cessation, nutrition, and more.

The results of this evaluation study were published in BMJ Open Quality.¹

“Training successfully increased clinician self-efficacy as well as aspects of the theory of planned behavior, with sustainment of improvements 1 year following training completion and less variability in clinician self-reported responses over time,” wrote the researchers of this study. “Improvements in self-efficacy support use of the implementation package as an effective method to positively influence clinician perceptions toward COPD management.”

COPD is the third-leading cause of death worldwide and is estimated to become the leading cause of death in the next 15 years. COPD is associated with persistent chronic cough and other exacerbations that lead to poor lung function and a worsening quality of life.

Although COPD outcome interventions have already shown to be effective in treating patients, adoption of these practices remains a challenge for the health care delivery system. The COPD CARE package uses evidence-based interventions and team-based methods of delivering care immediately after a patient has been discharged from the hospital or emergency department.

The aims of study were to evaluate the impact of the COPD CARE package on the use of evidence-based interventions for COPD management, and to investigate clinician perceptions of the implementation package.

To evaluate the impact of the implementation package, the researchers used data obtained from the Veterans Affairs (VA) Electronic Health Record (EHR), with the best practices grouped in “critical training aspects,” including: Patient referrals, specifically emphasizing patient immunizations, quitting smoking, and pulmonary rehabilitation; medication optimization, reflecting best practices in the Global Initiative for Chronic Obstructive Lung Disease 2020 guidelines; patient empowerment that emphasizes education provided during provision of a COPD Action Plan; and longitudinal follow-up care.

A total of 44 clinicians responded to the follow-up questionnaire, which measured improvements from baseline to immediately after 1 year of training completion. Of the clinicians who responded, 21 clinicians had completed the questionnaire and were included in the evaluation.

As a result, HER data showed a significant improvement in the number of COPD best practices that were incorporated into routine clinical care after training competition (P <.001), which was found among all critical training aspects.

Prior research² has found barriers to care that exist in COPD package implementation, including staff being too busy, staff shortages, lack of staff engagement, added workload, and patient coding challenges.

The researchers of this study suggest utilizing external facilitation, such as COPD CARE, to improve coordination and communication among patients and clinicians experiencing barriers to care. Furthermore, having online training packages helped the researchers overcome the barrier of staff being too busy.

Other logistical barriers identified by the researchers included coordinating a patient referral process, integrating note templates, and capturing patient outcomes.

“The next iteration of COPD CARE implementation package will, therefore, expand beyond clinician focused training to provide a more holistic approach to expansion of the COPD bundle,” concluded the researchers.

References

1. Portillo E, Lehmann M, Hagen T, et al. Evaluation of an implementation package to deliver the COPD Care Service. BMJ Open Quality. 2023;12(1). doi:10.1136/bmjoq-2022-002074

2. Lennox L, Green S, Howe C, et al. Identifying the challenges and facilitators of implementing a COPD care bundle. BMJ Open Respiratory Research. 2014;1(1). doi:10.1136/bmjresp-2014-000035