Evidence shows that COPD is more prevalent than statistics suggest, because COPD is under-diagnosed, particularly in primary care settings. Individuals who have undiagnosed COPD have poorer health outcomes than the general population, and opportunities to improve the health of people with undiagnosed COPD are being missed. In an educational collaboration, experts from National Jewish Health (NJH), recognized as the nation’s premier respiratory hospital, and key opinion leaders in pulmonary medicine from across the country joined forces to design the educational arm of a five-year, large-scale, National Institutes of Health (NIH)-funded, prospective study aimed to improve the diagnosis, management and treatment of COPD among primary care teams. The objective of the CAPTURE Study (COPD Assessment in Primary Care to Identify Undiagnosed Respiratory Disease and Exacerbation Risk) was to validate and integrate a new assessment tool for COPD and evaluate its impact on clinical care across a broad range of primary care settings.

Collaboration

The key collaborative partners of this educational initiative included 14 investigators of the CAPTURE Study, funded by the NIH; 110 primary care clinics within the five practice-based research networks (PBRNs); NJH, the accredited provider of the CME activities; and AstraZeneca Pharmaceuticals LP, the commercial supporter for the educational initiative supporting the CAPTURE Study Aims.

The NIH, a part of the U.S. Department of Health and Human Services, is the nation’s medical research agency — making important discoveries that improve health and save lives. The NIH-funded CAPTURE Study leveraged 14 expert principal investigators (PIs), two of whom are on faculty at NJH. An aim of the multi-year, multi-center CAPTURE Study was to provide foundational COPD education to both the control group and the treatment group that received additional education on the CAPTURE tool. NJH partnered with the CAPTURE Study planning committee to select expert faculty and a nurse educator to create and implement the educational curriculum and activities. As the leading respiratory hospital, NJH provided the expertise needed for evidence-based education on the diagnosis, management and treatment of COPD and served as the accredited provider. Additional funding to make the educational activities more robust and expand reach to additional healthcare providers was provided by an independent medical education grant from AstraZeneca Pharmaceuticals LP. After the production of the educational modules, the education was distributed to the PBRNs. Each PBRN also included centrally based research coordinators with a history of success working in PBRN practices, documented expertise in previous large diagnostic or therapeutic trials, and personnel experience in recruitment and data collection.

Program Design

The educational design of this initiative was grounded in adult learning theory and interprofessional education. The educational sessions at the PBRNs were one-hour sessions that included a pre-recorded session entitled “COPD101: Basic Diagnosis and Management” that the healthcare team went through as a group with a PI available via conference call for questions. This education involved the whole multidisciplinary team at each clinic site. Clinic participants’ knowledge was assessed before the pre-recorded session and after the session to measure knowledge and intent to change. They also were evaluated on their satisfaction with the educational activity and given access to additional education modules on topics such as spirometry technique, pharmacotherapy, smoking cessation, communication strategies and patient adherence.

Learning Objectives

• Apply updated clinical practice guidelines to the diagnosis and management of patients with COPD.
• Select pharmacological and non-pharmacological therapies for patients with COPD in accordance with updated clinical practice guidelines.
• Review proper inhaler technique, assessment of patients’ technique and strategies to improve patient adherence.
• Appraise the use of evidence-based strategies for effective communication in interactions with patients with COPD to improve engagement, self-management and coordination of care.

Outcomes

Live clinic sessions included participation from 616 members of the healthcare team with a breakdown of 42% MD/DO, 22% MA, 15% NP/PA, 10% LPN/RN, and 11% other. Learners from the 110 primary care clinics in the five PBRNs demonstrated a 38% relative knowledge gain from pre- to post-test. All learners indicated the learning objectives of the educational activity were met. Additional knowledge gains were seen related to the learning objectives of applying updated clinical practice guidelines to the diagnosis and management of patients with COPD (33%) and selecting pharmacological and non-pharmacological therapies for patients with COPD (72%). These large knowledge increases confirm the need for COPD education. Ninety-seven percent of clinic learners from the PBRNs also indicated they plan to make changes to their practice in the areas of changing screening/prevention practices, modifying treatment plans, incorporating different diagnostic strategies into patient evaluation, and using alternate communication approaches with patients and families.

The public online modules included participation from 705 primary care providers with a breakdown of 45% MD/DO, 20% NP, 6% PA, 9% RN, and 20% other. Ninety-seven percent of participants indicated the learning objectives of the educational activity were met. Clinic participants demonstrated a 48% relative knowledge gain from pre- to post-test. Additional knowledge gains were seen related to the learning objectives of applying updated clinical practice guidelines to the diagnosis and management of patients with COPD (52%), selecting pharmacological and non-pharmacological therapies for patients with COPD (42%), reviewing proper inhaler technique (40%) and appraising the use of evidence-based strategies for effective communication (52%). Ninety-five percent of clinic participants from the PBRNs also indicated they plan to make changes to their practice in the areas of changing screening/prevention practices, modifying treatment plans, incorporating different diagnostic strategies into patient evaluation, and using alternate communication approaches with patients and families.

Impact of Education

This innovative collaboration between an NIH-funded study and an accredited CME provider, NJH, indicated that targeted COPD education improved knowledge and intent to change practice by employing evidence-based recommendations to appropriately diagnose and manage patients with COPD. The education also addressed the aim of the NIH-funded CAPTURE Study to improve the early identification of patients with clinically significant COPD.

This initiative demonstrates to CPD providers that through careful collaboration and an emphasis on interprofessional education, independent medical education can support larger research goals that may change practice standards and impact population health. Educational outcomes from this collaboration reveal significant improvements in clinician knowledge related to COPD that will invariably translate to improved patient outcomes.

Acknowledgement

This educational activity was supported by an independent educational grant from AstraZeneca Pharmaceuticals LP as a supplement to NIH grant 1R01HL136682-01. The content was solely the responsibility of the authors and does not necessarily represent the official views of AstraZeneca, the NHLBI or the NIH.

Click here to view the poster presented at the 2021 Virtual Alliance Annual Conference.