Enhancing COPD management in primary care settings.

Abstract

Primary care physicians provide care for the majority of patients with mild-to-moderate chronic obstructive pulmonary disease (COPD). Although clinical practice guidelines have been developed for COPD, their influence on primary care practice is unclear. To examine primary care decision making, perceptions, and educational needs relating to COPD. A survey centered on COPD case-vignettes was developed and distributed to a random sample of physicians in adult primary care specialties. From 943 respondents, 784 practicing primary care physicians were used in analysis. On average, physicians estimated that 12% of their patients had COPD. Although 55% of physicians were aware of major COPD guidelines, only 25% used them to guide decision-making. Self-identified guidelines showed that users were more likely to order spirometry for subtle respiratory symptoms (74% vs 63%, P < .01), to initiate therapy for mild symptoms (86% vs. 77%, P < .01), and to choose long-acting bronchodilators for persistent dyspnea (50% vs 32%, P < .01). Practice guidelines and CME programs are both valued resources, but have not yet adequately reached many physicians. Because guidelines appear to influence clinical decision-making, efforts to disseminate them more broadly are needed. Future education should present COPD assessment algorithms tailored to primary care settings, assess and strengthen spirometry interpretation skills, and discuss a reasoned approach to medication management. Patient-centered content that accurately reflects the nature of primary care practice may enhance physician's learning experience. Internet-based and distance learning formats may be essential for reaching physicians in many high-need areas.