Early intervention for chronic obstructive pulmonary disease by practice nurse and GP teams: a cluster randomized trial

Zwar, Nicholas; Bunker, Jeremy; Reddel, Helen; Dennis, Sarah; Middleton, Sandy; Schayck, Onno C. P. van; Crockett, Alan; Hasan, Iqbal; Hermiz, Oshana; Vagholkar, Sanjyot; Xuan, Wei; Marks, Guy B.

doi:10.1093/fampra/cmw077

Cited by 82 publications

(84 citation statements)

References 25 publications

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“…Our diagnostic yield was only slightly lower than that obtained from screening programs utilized within Australian general practice settings (18%). 32 Recent data in primary care reiterate systematic issues in the Australian primary care setting, such as a reactive and relatively delayed approach to diagnosis. 33 Although cost-effectiveness analysis of the case-finding protocol was not attempted, our use of pharmacy-delivered microspirometry (instead of conventional spirometry), referring only those with high risk of COPD for onward GP review and diagnosis (instead of physicians undertaking the entire process from screening to diagnosis), the brevity of the case-finding protocol and the online modes (instead of face to face) of pharmacist training may render this model of COPD case detection more economic than conventional GP-based screening models where the onus of identifying, screening and testing potential COPD cases falls entirely upon the increasingly busy practices.…”

Section: Discussionmentioning

confidence: 99%

Community pharmacy-based case finding for COPD in urban and rural settings is feasible and effective

Fathima

Saini

Foster

et al. 2017

COPD

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Background and objectiveCase finding of patients at risk of COPD by community pharmacists could identify a substantial number of people with undiagnosed COPD, but little is known about the feasibility and effectiveness of pharmacy-based COPD case finding using microspirometry. The objective of this study was to assess the feasibility and effectiveness of COPD case-finding service provided by community pharmacists, utilizing a combination of risk assessment questionnaire and microspirometry.MethodsA 6-month service was conducted in 21 community pharmacies in Australia. Pharmacists trained in COPD case finding, including lung function test (LFT), invited their patients aged ≥35 years with a history of smoking and/or respiratory symptoms to participate. High-risk patients were identified via a COPD risk assessment questionnaire (Initial Screening Questionnaire [ISQ]) and underwent LFT. Pharmacists referred patients with a forced expiratory volume in 1 second (FEV1)/forced expiratory volume in 6 seconds (FEV6) ratio <0.75 to their general practitioner (GP) for further assessment and diagnosis.ResultsIn all, 91 of 167 (54%) patients had an ISQ score >3 indicating high COPD risk. Of the 157 patients who were able to complete LFT, 61 (39%) had an FEV1/FEV6 ratio of <0.75 and were referred to their GP. Patients with high ISQ symptoms scores (>3) were at a significantly higher risk of an FEV1/FEV6 ratio of <0.75, compared to patients with fewer COPD symptoms. A total of 15 (10%) patients were diagnosed with COPD by their GP. Another eight (5%) patients were diagnosed with other medical conditions and 87% of these were initiated on treatment. Although only half of all screened patients lived in regional areas, 93% of those diagnosed with COPD were from regional areas.ConclusionA brief community pharmacy-based COPD case-finding service utilizing the ISQ, LFT and GP referral is feasible and may lead to identification and diagnosis of a substantial number of people with COPD. This might be an important strategy for reducing the burden of COPD, particularly for those living in rural locations.

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Section: Discussionmentioning

confidence: 99%

Community pharmacy-based case finding for COPD in urban and rural settings is feasible and effective

Fathima

Saini

Foster

et al. 2017

COPD

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“…Since the majority of the Australian population visit their general practitioner (GP) more than once a year 7 , general practice offers the continuity of care needed for interventions aimed at enhancing patients' self-management of chronic disease. With practice nurses (PNs) increasingly contributing to chronic disease management, nurse-delivered self-management support for coordinated care of patients with COPD could lead to significant uptake of interventions shown to improve health outcomes such as smoking cessation, pulmonary rehabilitation and influenza vaccination 8,9 . For such interventions to be effective, patients need to be involved in active discussion that would enhance their self-efficacy for management of COPD 10 .…”

Section: Introductionmentioning

confidence: 99%

Activating primary care COPD patients with multi-morbidity through tailored self-management support

Ansari

Hosseinzadeh

Dennis

et al. 2020

npj Prim. Care Respir. Med.

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Given the dearth of COPD self-management interventions that specifically acknowledge multi-morbidity in primary care, we aimed to activate COPD patients through personalised self-management support that recognised the implications of co-morbidities. This single-group experimental study included patients aged 40−84 with a spirometry diagnosis of COPD and at least one co-morbidity. A self-management education programme for COPD in the context of multi-morbidity, based on the Health Belief Model, was tailored and delivered to participants by general practice nurses in face-to-face sessions. At 6 months' follow-up, there was significant improvement in patient activation (p < 0.001), COPD-related quality of life (p = 0.012), COPD knowledge (p < 0.001) and inhaler device technique (p = 0.001), with no significant change in perception of multi-morbidity (p = 0.822) or COPD-related multimorbidity (0.084). The programme improved patients' self-efficacy for their COPD as well as overall health behaviour. The findings form an empirical basis for further testing the programme in a large-scale randomised controlled trial.

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“…Firstly, GPs are not adequately reimbursed by Medicare to undertake pre- and post-bronchodilator spirometry with current reimbursement being only $34.95 from the Medicare Benefits Schedule which can only be claimed once in any 12-month period. A further barrier is that some GPs and practice nurses (PNs) lack confidence in the interpretation of spirometry [ 11 ] with one study reporting that GPs and PNs misinterpreted spirometry in 30% of cases [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have targeted people over the age of 40 years who are current or ex-smokers with a 10-year or more pack history and have focused on upskilling GPs, PNs or research assistants at performing these screening techniques. These methods have been shown to be effective with the identification of new cases of COPD ranging from 4 to 27%, as well as identifying a high rate of misdiagnosis [ 12 – 14 ].…”

Section: Introductionmentioning

confidence: 99%

The feasibility of an innovative GP-physiotherapist partnership to identify and manage chronic obstructive pulmonary disease (INTEGRATED): study protocol

Pagano

McKeough

Wootton

et al. 2020

Pilot Feasibility Stud

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Background Chronic obstructive pulmonary disease (COPD) contributes significantly to mortality, hospitalisations and health care costs worldwide. There is evidence that the detection, accurate diagnosis and management of COPD are currently suboptimal in primary care. Physiotherapists are well-trained in cardiorespiratory management and chronic care but are currently underutilised in primary care. A cardiorespiratory physiotherapist working in partnership with general practitioners (GPs) has the potential to improve quality of care for people with COPD. Methods A prospective pilot study will test the feasibility of an integrated model of care between GPs and physiotherapists to improve the diagnosis and management of people with COPD in primary care. Four general practices will be selected to work in partnership with four physiotherapists from their local health district. Patients at risk of developing COPD or those with a current diagnosis of COPD will be invited to attend a baseline assessment with the physiotherapist, including pre- and post-bronchodilator spirometry to identify new cases of COPD or confirm a current diagnosis and stage of COPD. The intervention for those with COPD will involve the physiotherapist and GP working in partnership to develop and implement a care plan involving the following tailored to patient need: referral to pulmonary rehabilitation (PR), physical activity counselling, medication review, smoking cessation, review of inhaler technique and education. Process outcomes will include the number of people invited and reviewed at the practice, the proportion with a new diagnosis of COPD, the number of patients eligible and referred to PR and the number who attended PR. Patient outcomes will include changes in symptoms, physical activity levels, smoking status and self-reported exacerbations. Discussion If feasible, we will test the integration of physiotherapists within the primary care setting in a cluster randomised controlled trial. If the model improves health outcomes for the growing numbers of people with COPD, then it may provide a GP-physiotherapist model of care that could be tested for other chronic conditions. Trial registration ANZCTR, ACTRN12619001127190. Registered on 12 August 2019—retrospectively registered.

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Early intervention for chronic obstructive pulmonary disease by practice nurse and GP teams: a cluster randomized trial

Abstract: Intervention uptake was low and had no additional beneficial effect, over usual care, on participants' health-related QoL.

Cited by 82 publications

References 25 publications

Community pharmacy-based case finding for COPD in urban and rural settings is feasible and effective

Community pharmacy-based case finding for COPD in urban and rural settings is feasible and effective

Activating primary care COPD patients with multi-morbidity through tailored self-management support

The feasibility of an innovative GP-physiotherapist partnership to identify and manage chronic obstructive pulmonary disease (INTEGRATED): study protocol

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