Multidisciplinary Team-Based Approach Shows Results in WV COPD Primary Care

A recent study found that the use of a multidisciplinary team-based approach in primary care was effective at improving patients’ ability to manage their chronic obstructive pulmonary disease (COPD) in rural areas, thereby keeping them out of the hospital.

COPD is the third leading cause of death in the United States and is estimated to account for over $49 billion in direct costs in 2020, the majority of which has been from hospitalizations secondary to exacerbations and other comorbidities. With that cost expected to rise, the researchers of the study noted that it is imperative to identify primary care interventions that can prevent complications.

Patients in rural areas of the United States, especially those along the Ohio and Mississippi Rivers, have a disproportionately greater incidence of COPD than other parts of the country, and have a more difficult time accessing health care. West Virginia leads the nation in COPD with a prevalence rate of nearly 14%. Nearly 25% of West Virginians are tobacco smokers, likely leading to the state’s high COPD incidence rates. Overall, residents of West Virginia, where 19% of the population live at or below the poverty line, suffer from some of the country’s highest rates of worse physical and mental health.

The study, published in the Journal of the American Board of Family Medicine, looked at a specialty COPD clinic in Morgantown, West Virginia that arms patients with a multidisciplinary team of health care providers, including a registered dietician, nurse, pharmacist, clinical psychologist, family medicine resident, and a board-certified family medicine attending physician.

Researchers from the clinic, created by the West Virginia University Department of Family medicine, conducted a retrospective chart review to evaluate the effectiveness of the program, which is aimed at reducing admissions and readmissions. Investigators included in their analysis patients who were referred to the clinic by a primary care physician and had at least 1 visit from February 2015, when the clinic first opened, to February 2019. During this time period, 142 patients with a mean age of 60.2 [10.3] were seen; 83 (56%) of patients were male and 83 (56%) had private insurance.

Study results showed that clinic patients had significantly fewer hospital admissions 6 months 0.09 [0.4]) and 1 year (0.2 [0.7]) after their first visit compared with 6 months (0.4 [0.8]) and 1 year (0.3 [0.6]) prior to their first visit (P <.0001).

Investigators also found that clinic patients had significantly fewer emergency department visits 6 months (0.1 [0.4]) and 1 year (0.2 [0.]) after their first visit compared with 6 months (0.4 [0.7]) and 1 year (0.5 [0.9]) prior (P <.0001).

Over the course of their clinic visits, patients had significantly lower COPD Assessment Test (CAT) scores at their most recent visit (20.5 [8.1]) compared with their first visit (23.7 [7.5]), P < .002).

Patients also reported that they were smoking significantly fewer cigarettes per day at their most recent clinic visit compared with their first visit.

Investigators said that tobacco cessation may be due to patients receiving reinforced messages about cessation during counseling sessions with the certified cessation specialist, the pharmacist, the psychologist, and the physicians.

“Patients may have also adjusted behaviors exclusively during this limited, intensive intervention, knowing they were being proactively monitored and observed,” investigators noted in the report.

Researchers said that future studies should assess the long-term impact of interdisciplinary care on outcomes, including whether tobacco cessation can be sustained.

Although investigators stressed that their results should be interpreted cautiously and that causality could not be established, they said that their results are promising.

“For practice sites interested in starting a multidisciplinary clinic, targeted strategies to identify disciplinary buy-in, evaluate gaps in care, develop an implementation plan, and discuss a clinic workflow are critical first steps for success,” the investigators suggested.

Reference

Peckens S, Adelman MM, Ashcraft AM, Xiang J, Sheppard B, King DE. Improving chronic obstructive pulmonary disease (COPD) symptoms using a team-based approach. J Am Board Fam Med. 2020;33(6):(158):978-985. doi: 10.1183/16000617.0039-2020