The Cochrane Review emphasizes the urgent need to identify the best type of interventions to improve management-recommended treatment for chronic obstructive pulmonary disease (COPD) and to improve patient-related outcomes in primary care settings.
Researchers from Monash University reviewed all available research by May 2021 and found that current models of educational activities for primary care professionals are not working and new approaches are needed.
Interventions and outcomes
In this review, the researchers included randomized controlled trials or studies of a similar design that examined educational activities aimed at any health care provider involved in the management of COPD in primary care. The research used a number of simple and complex interventions, including training of health professionals through sessions, seminars or online modules, providing practical support tools or toolkits, providing guidance on COPD clinical practice, and training on lung function tests. .
The first author, Dr Amanda Cross, who sits at the Monash Center for the Use of Medicine and Safety (CMUS), said: “There was little evidence that educational activities for health professionals improved COPD management, including the proportion of cases diagnosed with spirometry involved in pulmonary rehabilitation, or the proportion of patients prescribed respiratory medications for COPD are recommended recommendations.
“Interventions and outcomes varied widely between studies, and there were a number of limitations in the design and reporting of the studies included that affected the overall quality of the evidence.”
Professor Michael Abramson, a COPD expert from the Monash School of Public Health and Preventive Medicine, said: “Based on this review, we concluded that further high-quality research is needed to determine the effectiveness of educational interventions for health professionals treating COPD. in primary care to help improve outcomes for COPD sufferers ”.
The senior review author and member of the COPD Recommendations Committee of the Lung Foundation Australia, Dr Johnson George of CMUS, is conducting a new cluster randomized controlled trial to address some of the shortcomings in primary care associated with COPD treatment.
“COPD is not only a complex disease, but also a heterogeneous condition and requires a personal approach to medicine,” he said.
The TerRACOTTA Study on the Treatment of COPD for Prevention of Hospitalization will be the first of its kind to offer individualized interventions to treat COPD for people at risk of exacerbation to improve quality of life and avoid hospitalization.
Treatable traits refer to the individual assessment of patients for a specific set of treatable problems, followed by the development and implementation of an individual treatment program. Primary care is ideal for individual preventive measures and the beginning of early treatment aimed at curative traits.
George said that the results of the study will be effective in clinical practice and contribute to the continuous improvement of the quality of COPD: “COPD was the main reason for hospitalization due to chronic diseases in Australia in 2016-2019. Our study aims to demonstrate the effectiveness of coordinated interventions aimed at treatable traits in patients with moderate to severe COPD in general practice to improve health-related quality of life and reduce hospitalizations / emergency department visits.
“TERRACOTTA will focus on the national deployment of an interdisciplinary model of health care to inform about its expansion as a regular service,” George said.
A randomized controlled trial of TERRACOTTA was funded at the initiative of GSK researchers. The court has received the approval of ethical norms and the recruitment of patients should begin soon.