A checklist-based method for improving COPD care for the elderly in general practice: study protocol for a cluster randomized controlled trial using electronic health records

Anna Kowalczyk, Izabela Zakowska, Ewa Andrzejewska, Katarzyna Kosiek, Maciek Godycki-Cwirko, Anna Kowalczyk, Izabela Zakowska, Ewa Andrzejewska, Katarzyna Kosiek, Maciek Godycki-Cwirko

Abstract

Background: The third most frequent chronic condition, and the fourth most common cause of death, in Poland is chronic obstructive pulmonary disease (COPD). The diagnosis and treatment of COPD is the responsibility of the general practitioner (GP); the GP also serves as gatekeeper, referring patients to the other levels of public health care system when necessary. Undertreatment of COPD can result in a greater frequency of exacerbations and hospitalizations. Elderly patients require special attention due to the increased prevalence of COPD and systemic comorbidities. However, both the occurrence of exacerbations and the quality of life of the patients may be improved by developing and implementing guidelines for practice and ensuring their adherence. This proposal concerns the development of a checklist-based educational program to assist general practitioners in managing COPD patients.

Methods: No less than eighty-four general clinics in the Lodz region, Poland (28 clusters in each of three study arms), will be identified, randomized, and included in the trial. The trial will be based on anonymized data in electronic health records within the national public health care system. The educational intervention program will consist of GPs in two intervention arms being provided with a COPD management checklist: those in the first intervention arm with receive the checklist once at the beginning, while those in the second with receive it twice. The third (control) arm receives standard care without the checklist. The study used the International Code of Diseases (ICD)-10 for COPD. The primary aim is to determine the effect of interventions delivered to general practitioners (GPs) in primary health care. These interventions are aimed at decreasing the hospitalization of elderly patients with medical code J-44 (COPD) as the main reason for hospital admission.

Discussion: The results of this trial will be directly applicable to primary care in Poland and add new data to the growing body of evidence regarding interventions aimed at improving chronic illness care.

Trial registration: This trial has been registered with the Clinical Trials Protocol Registration System. Please see in ClinicalTrial.gov identifier (NCT Number): NCT04301505 . Registered on 10 March 2020.

Keywords: COPD; Checklist; Elderly; Electronic health records; Exacerbations; Prevalence; Randomized controlled trial.

Conflict of interest statement

The authors declare no competing interests.

Figures

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Fig. 1
The schedule of the study

References

    1. Hansen JG, Pedersen L, Overvad K, Omland O, Jensen HK, Sorensen HT. The prevalence of chronic obstructive pulmonary disease among Danes aged 45-84 years: population-based study. Copd J Chronic Obstruct Pulmon Dis. 2008;5(6):347–352. doi: 10.1080/15412550802522635.
    1. Henderson J, Harrison C, Miller G. Management of COPD in general practice. Aust Fam Physician. 2012;41(11):841.
    1. Plywaczewski R, Bednarek M, Jonczak L, Zieliński J. Prevalence of COPD in Warsaw population. Pneumonol Alergol Pol. 2003;71(7–8):329–335.
    1. Nizankowska-Mogilnicka E, Mejza F, Buist AS, Vollmer WM, Skucha W, Harat R, et al. Prevalence of COPD and tobacco smoking in Malopolska region--results from the BOLD study in Poland. Pol Arch Med Wewn. 2007;117(9):402–410.
    1. May SM, Li JT. Burden of chronic obstructive pulmonary disease: healthcare costs and beyond. Allergy Asthma Proc. 2015;36(1):4–10. doi: 10.2500/aap.2015.36.3812.
    1. Albertson TE, Louie S, Chan AL. The diagnosis and treatment of elderly patients with acute exacerbation of chronic obstructive pulmonary disease and chronic bronchitis. J Am Geriatr Soc. 2010;58(3):570–579. doi: 10.1111/j.1532-5415.2010.02741.x.
    1. Jarad N. Chronic obstructive pulmonary disease (COPD) and old age? Chron Respir Dis. 2011;8(2):143–151. doi: 10.1177/1479972311407218.
    1. Schermer TR, Akkermans RP, Crockett AJ, van Montfort M, Grootens-Stekelenburg J, Stout JW, Pieters W. Effect of e-learning andrepeated performance feedback on spirometry test quality in familypractice: a cluster trial. Ann Fam Med. 2011;9(4):330–336. doi: 10.1370/afm.1258.
    1. Loekke A, Soendergaard J, Hansen MK, Poulsen SV, Roslind K, Lange P. Real life management of chronic obstructive pulmonary disease (COPD) in general practice (GP) in Denmark. Eur Respir J. 2015;46:PA1812.
    1. van Bokhoven MA, Kok G, van der Weijden T. Designing a quality improvement intervention: a systematic approach. Qual Saf Health Care. 2003;12(3):215–220. doi: 10.1136/qhc.12.3.215.
    1. Bollmeier SG, Hartmann AP. Management of chronic obstructive pulmonary disease: a review focusing on exacerbations. Am J Health Syst Pharm. 2020;77(4):259–268. doi: 10.1093/ajhp/zxz306.
    1. Foster JA, Yawn BP, Maziar A, Jenkins T, Rennard SI, Casebeer L. Enhancing COPD management in primary care settings. MedGenMed. 2007;9(3):24.
    1. Godycki-Cwirko M, Zakowska I, Kosiek K, Wensing M, Krawczyk J, Kowalczyk A. Evaluation of a tailored implementation strategy to improve the management of patients with chronic obstructive pulmonary disease in primary care: a study protocol of a cluster randomized trial. Trials. 2014;15:109. doi: 10.1186/1745-6215-15-109.
    1. Krause J, Van Lieshout J, Klomp R, Huntink E, Aakhus E, Flottorp S, et al. Identifying determinants of care for tailoring implementation in chronic diseases: an evaluation of different methods. Implement Sci. 2014;9:102. doi: 10.1186/s13012-014-0102-3.
    1. Chan AW, Tetzlaff JM, Gøtzsche PC, Altman DG, Mann H, Berlin JA, et al. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ. 2013;346:e7586. doi: 10.1136/bmj.e7586.
    1. Donner A, Klar N. Analysis of binary outcomes. In: Arnold, editor. Design and analysis of cluster randomization trials in health research. 2000. pp. 79–110.
    1. Campbell MK, Thomson S, Ramsay CR, MacLennan GS, Grimshaw JM. Sample size calculator for cluster randomized trials. Comput Biol Med. 2004;34(2):113–125. doi: 10.1016/S0010-4825(03)00039-8.
    1. Elley CR, Kerse N, Chondros P, Robinson E. Intraclass correlation coefficients from three cluster randomised controlled trials in primary and residential health care. Aust N Z J Public Health. 2005;29(5):461–467. doi: 10.1111/j.1467-842X.2005.tb00227.x.
    1. Sandelowsky H, Krakau I, Modin S, Ställberg B, Nager A. Case method in COPD education for primary care physicians: study protocol for a cluster randomised controlled trial. Trials. 2017;18(1):197. doi: 10.1186/s13063-017-1889-4.
    1. GOLD . Report. 2020 Global Strategy for Prevention, Diagnosis and Management of COPD. 2020.
    1. CMS. 2016 Physician quality reporting system (PQRS): implementation guide: American Medical Association. Centers for Medicare & Medicaid Services (CMS); 2016. Accessed 14 Apr 2020

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