None listed
Conditions
Brief summary
Chronic obstructive pulmonary disease (COPD) is a complex chronic disease that is characterised by a progressive deterioration of pulmonary function punctuated with exacerbations that frequently require hospitalisation. COPD affects approximately 2.1 million Australians and it is the 4th leading cause of death in this country. Evidence-based guidelines for clinical management of COPD are widely available, however concordance with treatment guidelines is relatively low in the primary care setting. Numerous barriers to guideline adherence have been identified, and there are evidence-based approaches that could be used to address these barriers. Currently, there is no formal, systematic process for specialists to provide personalised, guideline-based recommendations to GPs beyond the traditional referral letter. This prospective randomised controlled trial will test the effect of an electronic checklist, the “COPD Snapshot”, on the management of outpatients with COPD. We aim to determine whether this checklist will improve GP uptake of specialist treatment recommendations. Patients attending the outpatient clinic at The Prince Charles Hospital will be invited to participate in the study. After obtaining written informed consent, participants will be randomly allocated to either a control group or an intervention group. The control group will receive usual best practice care from their thoracic physician. The intervention group will receive a COPD Snapshot in addition to usual best practice care form their thoracic physician. The COPD Snapshot is a communication tool that is contained on a credit card-sized USB stick. It is a checklist-format adaptation of the Lung Foundation Stepwise Management of Stable COPD Guidelines. This Snapshot will contain key management points that have been identified by each patient’s thoracic physician as requiring ongoing review by the patient’s GP. The electronic Snapshot will be completed during the clinic appointment and given to the participant at the end with instructions to give it to their GP to review when they next attend for ongoing care, within the next 2 months. After reviewing the Snapshot, GPs will return it to their patient and complete a brief, 3-question survey. After attending follow up with their GP, participants will return the COPD Snapshot to the investigators by mail in a pre-addressed envelope. In addition, participants will complete a brief follow up survey regarding their experience with the Snapshot and the clinical care they received. We will assess whether the COPD Snapshot has an effect on GP implementation of specialist treatment recommendations. In addition, we will assess the feasibility of the Snapshot, clinician uptake, and clinician and patient satisfaction.
Interventions
Patients in the intervention group will receive a COPD Snapshot for the duration of the study. The COPD Snapshot is a communication tool that is a checklist-format adaptation of the Lung Foundation Stepwise Management of Stable COPD Guidelines. This Snapshot will be developed and piloted in-house in the initial phase of this project, and will contain key management points that have been identified by each patient’s thoracic physician as requiring ongoing review by the patient’s GP. It will also
Patients in the intervention group will receive a COPD Snapshot for the duration of the study. The COPD Snapshot is a communication tool that is a checklist-format adaptation of the Lung Foundation Stepwise Management of Stable COPD Guidelines. This Snapshot will be developed and piloted in-house in the initial phase of this project, and will contain key management points that have been identified by each patient’s thoracic physician as requiring ongoing review by the patient’s GP. It will also contain relevant recent investigation results, current medication list, and allergies. In addition, the Snapshot will be accessible if patients attend the ED. Utilisation of the Snapshot by ED will be monitored as a guide to feasibility for potential future expansion of the Snapshot scope based on initial results. The Intervention Group (n=100 participants) will receive an electronic personalised COPD Snapshot in the form of a credit card sized USB stick, in addition to usual care from their thoracic physician (consultation, and clinic letter to GP). The electronic Snapshot will be given to participants during their consultation at the respiratory outpatient clinics. They will be asked to provide it to their GP to review when they next attend for ongoing care, within the next 2 months. After reviewing the Snapshot, GPs will return it to their patient and complete a brief, 3-question satisfaction survey. After attending follow up with their GP, participants will return the COPD Snapshot to the investigators by mail in a pre-addressed envelope. In addition, participants will complete a brief follow up survey (free text comments from patient and/or telephone interview) regarding their experience with the Snapshot and the clinical care they received.
Sponsors
The Prince Charles Hospital
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
0 to No maximum
Healthy volunteers
No
Inclusion criteria
- Adult patients of any age with thoracic-physician diagnosed COPD. - COPD diagnosis will be based on Global Initiative in Obstructive Lung Disease (GOLD) spirometric criteria of post-bronchodilator FEV1<80% predicted and FEV1/FVC <70%.
Exclusion criteria
- Inability to give written informed consent. - Presence of other respiratory conditions which are more predominant than the COPD (e.g. asthma; bronchiectasis; interstitial lung disease; current lung cancer). Patients with previously treated lung cancer, without known current active lung cancer, will be able to be included. - No current regular general practitioner. - High care level in a residential care facility. - Women who are pregnant.
Outcome results
None listed