Assessing the Needs of Primary Care Physicians
On January 17, 2007, the COPD Foundation jointly conducted a study with Outcomes, Inc. to evaluate the current primary care patterns in outpatient COPD management and to identify aspects of COPD care that should be targeted by educational initiatives. The key findings from this study are outlined below. There is also a link to the full text as it appears on Medscape.
Key Findings: Enhancing COPD Management in Primary Care Settings
Physicians want more education on COPD management.
- It was found that 61.1% of Primary Care Physicians (PCPs) considered their recent COPD education exposure inadequate for their needs.
Physicians value clinical practice guidelines to help guide clinical practice, but have low awareness of COPD specific guidelines.
- According to 64.4% of primary care physicians, clinical practice guidelines are the most important tool used in helping them provide optimal patient care.
- 44.9% of primary care physicians are unaware of clinical practice guidelines.
Spirometry poses significant challenges to PCP’s as it is the primary tool for confirming and staging COPD.
- 38.6% of PCPs lack spirometry in their practice. Of those with spirometry available, a third (35.6%) do not use it routinely. Compared to high utilizers, these low-utilizers are less likely to order spirometry for patients with subtle COPD symptoms (22.5% vs 45.5%) and have greater difficulty interpreting simple spirometry parameters than routine users.
- 64.8% of primary care physicians know how to use simple spirometry parameters to diagnose and stage COPD.
PCP’s under-utilize optimal bronchodilator therapies in patients with COPD and over-utilize therapies with significant potential for adverse effects.
- Long-acting bronchodilators are recommended as first line therapy to control persistent COPD symptoms, but are not the drug of choice for PCP’s. In a patient with moderate-to-severe COPD who has not responded to initial therapy, only 36% appropriately chose a long-acting bronchodilator. According to guidelines, severe COPD should be treated with LABAs and steroids – particularly if there are exacerbations. Another problem here relates to the overlap between asthma and COPD, which can be substantial.
- PCPs often use inhaled steroids inappropriately in COPD patients, despite their significant risk for adverse effects. Given a spirometry confirmed diagnosis of COPD, inhaled corticosteroids were chosen as initial therapy by 30.1% of PCP’s. This may be the appropriate therapy in patients who have asthma and COPD overlap.
The biggest obstacles to optimal COPD management in primary care were identified as the challenge of recognizing patients with early COPD and limited educational resources for patients with newly diagnosed COPD.
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