This weekend at the American College of Chest Physicians annual meeting Chest 2010 in Vancouver, British Columbia, Nicola Hanania, M.D., M.S. Associate Professor of Medicine Director, Asthma Clinical Research Center Pulmonary and Critical Care Medicine, Baylor College of Medicine, presented outcomes findings from a recent study on the effectiveness of a continuing medical education (CME) activity.
COPD Diagnosis and Evaluation accredited by the Potomac Center for Medical Education (PCME), and supported through an educational grant from Novartis, was targeted towards primary care practices, general practitioners, or primary care providers (PCPs), under-recognize, underdiagnose, and undertreat COPD. PCPs will less commonly consider a diagnosis of COPD than other diagnoses with fewer symptoms (e.g. hypertension or diabetes). There is also a lack of awareness of COPD guidelines: Patients with COPD receive guideline-recommended care during only 30% to 55% of encounters. Another problem facing PCPs is the underutilization of spirometry for staging and monitoring: 36% of PCPs lack spirometry; among those with spirometry, 34% do not use it routinely.
To address this gap in care and lack of awareness and knowledge surrounding COPD, PCME held a series of 12 regional, live, half-day meetings between September and December 2009 entitled, “Improving COPD Patient Outcomes: Breaking Down the Barriers to Optimal Care.” These programs, which included 767 PCPs, were a mix of proven adult-learning formats, which included a series of short (25-30 min) didactic lectures and a video on the correct use of inhaler devices. The programs also used small-group workshops that went into detailed case discussions, where doctors treated “virtual patients,” and included hands-on demonstrations of the correct use of hand-held spirometers, along with active role-playing of spirometry coaching, reading and interpretation.
The goals of these programs, upon successful completion, were for primary care physicians to be able to:
- Describe the demographics of COPD burden and explain the impact of patient comorbid conditions on COPD outcomes and management
- Obtain reliable office spirometry results through proper patient education and coaching
- Diagnose, stage, and manage a patient with COPD with a combination of management strategies, including risk reduction and pharmacologic and nonpharmacologic interventions per guideline recommendations
- List emerging therapies for the management of COPD
- Implement patient-oriented strategies to optimize adherence and improve outcomes
To measure whether these programs were successful in meeting these educational objectives and goals, PCME and CE Outcomes, LLC, surveyed a subgroup of participants (n=50) at the end of each program, and demographically matched non-participants (n=50). The survey included detailed case vignettes, a validated tool for measuring physician performance in clinical practice. Case vignettes were designed to assess the consistency of diagnostic and therapeutic choices with clinical evidence. An assessment was then designed to determine:
– Whether the diagnostic and therapeutic choices of participants were consistent with the clinical evidence presented during the educational activity
– Whether practice choices of participants were different from practice choices of non-participants
– Barriers to the optimal management of COPD
One significant finding from the study showed that participants in the CME program were 50% more likely than non-participants to provide evidence based care. CME program participants were also more likely than non-participants to:
– Correctly recognize COPD in a patient presenting with dyspnea (94% vs 74%; P=0.007)
– Recognize that women may have a greater susceptibility than men to the toxic effects of smoking (90% vs 54%; P<0.001)
– Identify the mechanisms of action of emerging therapies (65% vs 33%; P=0.003)
– Report and demonstrate increased familiarity with the GOLD guidelines
– Correctly determine disease severity (58% vs 44%) based on FEV1
– Select a strategy for maintenance therapy
– Demonstrate a greater willingness to use office-based spirometry in the initial assessment of suspected COPD (98% vs 90%) and long-term monitoring (86% vs 76%)
– Report a lower level of familiarity with spirometry measurements
The findings were presented orally with accompanying slides during the session “COPD Diagnosis and Evaluation,” on Sunday, October 31. The study results will also be shown as an electronic poster presentation at the annual meeting. In addition, the findings of the survey will be published in the October 2010 online supplement to the journal Chest.
Ultimately, these findings are significant because each of these areas that saw significant improvement from CME participation had been identified as gaps in current COPD clinical practices. As a result, these findings show that CME can help narrow these gaps.