Does Evaluation and Management of COPD Follow Therapeutic Strategy Recommendations

Introduction COPD diagnosis and management requires symptoms and exacerbation risk assessment. Adherence to these recommendations appears to be limited. We examined the impact of a COPD quality improvement (QI) program in the Southeastern United States. Methods From 2017 to 2018 nine pulmonary and 15 primary care physicians were included and asked to identify six to seven of their COPD patients using maintenance COPD medications with at least two office visits in the past year. A separate group of COPD patients (n=135 pulmonary and 165 primary care) from the same practices were evaluated. Physicians underwent focused, educational, peer-to-peer small group webinars. Data were collected from physicians and their patients using a systematic survey. Chart audits occurred at baseline and six months after the webinars. Results The majority of physicians (67%) saw ≥ 20 COPD patients/week. There were important discrepancies between the care clinicians thought they provided and the care recalled by their patients. Clinicians felt that 33% of their patients experienced at least 2 exacerbations in the past year; 56% of their patients reported this frequency. There was discrepancy in the clinicians' interpretations and the patients' reasons for discontinuing their medications and in the use of referrals. Self-reported changes were noted by clinicians after educational webinars and improvements in patient care were noted in the year following intervention. Conclusion We identified notable discrepancies between the impression of care provided by clinicians and the components actually recalled by their patients, and improvements in processes of care and outcomes following an educational intervention based on the principles of audit and feedback.