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Pharmacy and Pharmaceutical Sciences
To evaluate the efficacy of provider education on adherence to guideline directed therapy in outpatient chronic obstructive pulmonary disease (COPD) management in South Oregon PMG clinics.
• COPD is the third most common cause of death in the US • The CDC reports costs attributable to COPD in 2010 were $32.1 billion projected to have increased to $49 billion by 2020 • Direct healthcare costs include detection, prevention, physician office visits, hospitalizations, home care, and medications hospitalizations accounting for about 45 50% of these direct costs • Clinical burden of uncontrolled COPD has been shown to impact quality of life, health status, daily activities, physical activity, sleep, comorbid anxiety and depression, and disease progression • Data indicates a direct relationship between severity of COPD and overall cost of care. Studies have also shown that adherence to guideline directed therapy for COPD decreases trends in cough and shortness of breath, exacerbations, emergency department visits, and hospitalizations • PMG Clinical Pharmacists have shown positive outcomes in collaborative management of chronic disease states such as diabetes, hypertension, and cardiovascular risk reduction, making pharmacists well positioned to provide education on guideline adherence
Methodology • Primary Outcome • Change in provider adherence to guideline directed therapy in COPD management after provider education as determined by pre and post surveys • Secondary Outcome • Change in percentage of patients where a CAT/ mMRC score was reported before and after survey intervention • Baseline reporting of pulmonary function tests ( • Change in percent appropriateness of inhaler therapy between February 2021 and March 2021 pre and post provider education as determined by guideline recommended therapy
Interventions: • Comparison of pre and post survey responses following provider education sessions for the primary objective • Chart review of January 2021 and March 2021 for secondary objectives Inclusion Criteria: • Providers: • PMG primary care providers in Southern Oregon clinics • Providers who choose to complete pre and post surveys • Patients: • •≥18 years with confirmed diagnosis of COPD Exclusion Criteria: • Providers: • Pulmonologists • Patients: • Asthma/COPD and asthma diagnoses • Elevated IgE levels (>0.35 kIU /L) if obtained
Primary Outcome: • There was statistically significant improvement seen after provider education for classification and initial treatment of COPD management as determined by pre and post surveys. • Other findings from provider surveys include: • Cost of inhalers was reported to be a barrier in COPD management 75 90% of the time. • Other overarching barriers identified include patient adherence, smoking cessation, formulary changes, and time and availability with the patient. Limitations: • Reduced post survey responses submitted after each provider education session. Pre survey and post survey answers were unable to be matched for analysis. Secondary Outcome: • All CAT/mMRC score reporting were conducted by pulmonology specialty and no change in reporting was seen in primary care clinics. • There was a change in baseline reporting of PFTs between January 2021 and March 2021 in primary care clinics. Two baseline PFTs were obtained in February 2021 post provider education. Limitations: • Chart review only captured patients who presented to clinic for COPD in the months of January 2021 and March 2021. Potential to have missed other patients with baseline PFT and/or mMRC/CAT score reporting. • Percent appropriateness of inhaler therapy depended on CAT/mMRC score reporting.
• Pharmacist led provider education positively impacted COPD management as determined by pre and post surveys • Barriers identified for optimized COPD therapy fall under the scope for management by clinical pharmacy • Further workflows to improve obtaining baseline PFTs and symptom reporting in primary care settings is needed
Graduate Medical Education
Conference / Event Name
Academic Achievement Day, 2021
Providence Medical Group
Dominguez, Erica; Rosati, Ben; and Laursen, Trevor, "Impact of pharmacist led provider education on outpatient COPD management" (2021). Providence Pharmacy PGY2 Program at Providence Medical Group 2021. 1.