Improving Chronic Obstructive Pulmonary Disease (COPD) Symptoms Using a Team-Based Approach

Shaylee Peckens, MD; Megan M. Adelman, PharmD; Amie M. Ashcraft, PhD, MPH; Jun Xiang, MS; Brittany Sheppard; Dana E. King, MD, MS

Disclosures

J Am Board Fam Med. 2020;33(6):978-985. 

In This Article

Abstract and Introduction

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States (US), with West Virginia bearing a disproportionate disease burden. Complex COPD cases can be difficult to manage during a standard primary care provider (PCP) visit, and pharmacological treatment regimens should be individually tailored to each patient.

Methods: To address these needs, the West Virginia University Department of Family Medicine created an interdisciplinary COPD specialty clinic that uses a team-based approach to treat patients with COPD. In order to evaluate the effectiveness of the specialty clinic, we conducted a retrospective chart review to examine the impact of the clinic on patient hospitalizations, emergency department visits, and urgent care visits six months and one year before and after initiating care at the clinic. We also examined the impact of the clinic on patients' self-reported nicotine dependency, COPD symptoms, and tobacco use behavior. Patients referred to the clinic and having at least one visit from February 2015 to February 2019 were included in this study (n = 149).

Results: Patients treated at the COPD specialty clinic had significantly fewer hospital admissions and ED visits six months after and one year after initiating care at the clinic as compared to six months before and one year before, respectively. Patients at this clinic also reported smoking significantly fewer cigarettes per day with significantly fewer self-identifying as smokers and experiencing significantly reduced COPD symptoms.

Conclusion: An interdisciplinary, team-based approach was effective for improving the health of COPD patients in an Appalachian academic primary care practice.

Introduction

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States.[1] Age-adjusted mortality has not changed significantly since the 1990s.[2] Geographically, states clustered along the Ohio and Mississippi Rivers seem to suffer disproportionately compared with their national counterparts.[2] In addition, COPD is estimated to account for over $49 billion in direct costs in 2020 with the majority of the cost burden from hospitalization secondary to exacerbations and other concomitant chronic conditions.[3] Multiple studies predict COPD's prevalence will continue to rise, with 1 estimate predicting an annual increase of 4.8% per year due to the growing older adult population and the increasing prevalence of tobacco use in various areas globally.[4]

Nationally, West Virginia (WV) ranks among the highest in the nation in poor physical and mental health secondary to limited health care access and services, socioeconomic barriers, and high rates of chronic disease states.[5] Based on data from the WV Behavioral Risk factor Surveillance System, WV had the highest rates of COPD across the United States (13.9%).[5] One of the major drivers to COPD development is tobacco use. Nearly 25% of West Virginians currently smoke, ranking them as the second highest in the nation.[5] Only about 55% of these current smokers have previously tried to quit smoking in the past year.[5] In addition, WV continuously ranks as one of the poorest states in the nation with ~19% of the population considered to be at or below the poverty line; this economic burden limits the ability for patients to pay and access health care.[5] This—among other barriers, such as a lack of access to care and cost of COPD inhaler treatment—impacts the success of outpatient COPD management.

Pharmacological treatment regimens should be individualized to the patient, and are often guided by cost, drug availability, ease of use, and patient benefit. It can be difficult for providers to manage a complicated COPD case during a standard 15-to-20-minute primary care provider (PCP) office visit—especially in conjunction with other chronic conditions and acute concerns. Many PCPs have transitioned to the "team-based" care approach with the widely accepted implementation of the patient center medical home concept, and it has been demonstrated to improve health, enhance the care experience, and reduce costs in primary care settings. Previous literature has demonstrated the impact of a holistic, team approach for COPD management and beneficial outcomes on patient outcomes.[6,7] Studies by Koff and colleagues[6] and Liang and colleagues[7] demonstrated multidisciplinary care resulted in improved symptoms and quality of life while also decreasing overall health care expenditure compared with standard of care (ie, primary care provider only). This study evaluated the effectiveness of a team-based approach to improving patients' COPD management in a rural primary care clinic in Appalachia.

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