Research has shown that patients with COPD from different geographic regions in the United States are disproportionately affected by the disease. “West Virginia has some of the highest rates of smoking, poverty, and poor healthcare access in the nation, which has led to higher rates of complex COPD cases that can be difficult to manage,” says Shaylee Peckens, MD, PCMH, CCE.

To help patients with COPD avoid disease progression, individualized treatment plans are necessary. “These plans should provide pharmacologic treatments guided by cost, availability, and effectiveness; personalize smoking cessation plans; and assess mental health,” Dr. Peckens says. “Unfortunately, it can be especially difficult to address all these factors in the context of managing other chronic diseases and acute care issues during a standard 15-to-20–minute primary care provider (PCP) office visit.”

The Team-Based Approach to COPD Management

For a study published in the Journal of the American Board of Family Medicine, Dr. Peckens and colleagues at the West Virginia University Department of Family Medicine evaluated a team-based approach they implemented to improve COPD management. “Patients were referred by their PCPs within our department or upon hospital discharge from our inpatient family medicine service,” explains Dr. Peckens. “The interdisciplinary team consisted of a registered dietician—who is also a certified tobacco treatment specialist (CTTS)—a clinical pharmacist, a clinical psychologist, and a family medicine attending physician. Each team member addressed their area of expertise during patient visits. In addition to individualizing care, our goal was to improve symptoms and, thus, reduce readmissions and future hospital admissions.”

According to Dr. Peckens, a key aspect of their team approach was that it addressed both barriers to care and goals of care. “If a patient is still smoking, Fagerstrom and COPD assessment tests are used to gauge the level of nicotine dependence and how patients rate their symptoms,” she says. “Our dietician/CSST provides nutrition and smoking cessation counseling. Behavioral assessments are performed by a trained psychologist. Our clinical pharmacist reviews the patient’s entire medication list, reinforces correct inhaler techniques, and discusses treatment affordability. Finally, the physician examines the patient and ties it all together. After each team member interacts with the patient, a group huddle takes place between team members to discuss management plans.”

The team-based approach provides other important advantages for patients. “Patients typically have reduced or no co-pay for their PCP office visit in comparison to a specialty clinic visit, which might have a significantly higher co-pay,” says Dr. Peckens. “In addition, our interdisciplinary clinic is housed in the same clinic as their PCP; this gives patients familiarity and comfortability. We’re also able to perform in-office pre- and post-bronchodilator spirometry testing during clinic visits. This can benefit patients who haven’t been formally diagnosed with pulmonary function testing.”

Improved COPD Outcomes

For the study, a retrospective chart review of 149 patients was conducted to examine the impact of the clinic on patient hospitalizations, emergency department (ED) visits, and urgent care visits at 6 months and 1 year before and after initiating care at the clinic. The study team also examined the impact of the clinic on patients’ self-reported nicotine dependency, COPD symptoms, and tobacco use behavior.

“We found that patients treated at our COPD specialty clinic had significantly fewer hospital admissions and ED visits at 6 months and 1 year after initiating care at our clinic when compared with 6 months and 1 year before receiving care at the clinic, respectively,” Dr. Peckens says (Table). “Through our standardized assessments, we also found that patients were smoking less and had significant reductions in their COPD symptoms.”

A “One-Stop Shop”

Dr. Peckens says the resources provided at the West Virginia University COPD clinic may not otherwise be available for most patients, especially the underserved. “Our COPD clinic can serve as a ‘one-stop shop’ to deliver services, education, and individualized treatment to patients with COPD and ensure that any other chronic disease or healthcare challenges are addressed,” she notes. “By taking in some of these patients, we hope that we’re also helping to reduce PCP burnout.”

References

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;33:978-985. Available at: https://www.jabfm.org/content/33/6/978.long .

Koff PB, Jones RH, Cashman JM, Voelkel NF, Vandivier RW. Proactive integrated care improves quality of life in patients with COPD. Eur Respir J. 2009;33:1031-1038.

Liang J, AbramsonMJ, RussellG, et al. Interdisciplinary COPD intervention in primary care: a cluster randomized controlled trial. Eur Respir J. 2019;53:1801530.

Braman SS, Lee DW. Primary care management of chronic obstructive pulmonary disease: an integrated goal-directed approach. Curr Opin Pulm Med. 2010;16:83-88.