Disconnects in Physician and Patient Perceptions of COPD Disease Assessment

Abstract

SESSION TITLE: Patient Safety and Quality Improvement SESSION TYPE: Original Investigation Slide PRESENTED ON: Tuesday, October 31, 2017 at 02:45 PM - 04:15 PM PURPOSE: Recent changes to the ABCD assessment tool of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy for COPD emphasize the importance of patient symptoms and exacerbation history for pharmacotherapy decision-making, with spirometry remaining essential for diagnosis. Physician alignment with these evidence-based recommendations requires not only clinical skills and competence, but also good communication with patients. This study was designed to assess perceptions among physicians and their own COPD patients on specific aspects of patient assessment. METHODS: Surveys were completed by 17 physicians (10 pulmonologists, 7 primary care physicians) and 40 of their patients with a diagnosis of COPD. The surveys included items for both groups to report their perceptions on spirometry utilization, COPD symptom assessment, and exacerbation history. The study was conducted in the context of a quality improvement medical education program for providers affiliated with health systems in Alabama and Florida. RESULTS: Physicians reported ordering spirometry at higher rates than their patients reported receiving spirometry: 88% of physicians, but only 35% of patients, reported ordering and receiving spirometry at diagnosis, respectively (P < 0.001). Only 38% of patients reported having spirometry within the past year; 47% and 53% of physicians reported ordering spirometry during routine monitoring and acute change in symptoms, respectively. Few physicians reported routinely using a validated tool to assess COPD symptoms: 6% reported using such tools “always” or “most of the time”; 41% “sometimes”; and 53% “never” or “rarely”. However, the majority of patients (60%) reported that their providers asked about COPD symptoms “at every visit”. Although 82% of physicians reported asking about COPD exacerbations at “every visit” or at “most visits”, physicians underestimated the proportion of patients who reported having had ≥ 2 COPD exacerbations in the past year (36% vs 60%, P = 0.087). CONCLUSIONS: Using a detailed survey of patients with COPD and their physicians, we found substantial discordances in physician and patient perceptions of clinical assessment in areas that are key for appropriate COPD treatment and management decisions. CLINICAL IMPLICATIONS: Practical strategies are needed to support utilization of spirometry and validated COPD symptom assessment tools, and to improve assessment of COPD exacerbation history in clinical practice. DISCLOSURE: Fernando Martinez: Grant monies (from industry related sources): Afferent, AstraZeneca, Bayer, Bioscale/ProterrixBio, Boehringer Ingelheim, GlaxoSmithKline, Consultant fee, speaker bureau, advisory committee, etc.: Afferent, AstraZeneca, Boehringer Ingelheim, Columbia University, ConCert, Genentech/Roche, Gilead, GlaxoSmithKline, Methodist Hospital, National Association for Continuing Education, New York University, Peer View, Puerto Rican Respiratory Society, Respiration Day/Chiesi, Stromedix/Biogen, WebMD/MedScape, Western Connecticut Health Network , Other: Stromedix/ Biogen Byron Thomashow: Consultant fee, speaker bureau, advisory committee, etc.: Boehringer Ingelheim MeiLan Han: Consultant fee, speaker bureau, advisory committee, etc.: AstraZeneca, Sunovion, GlaxoSmithKline, Boehringer Ingelheim, Novartis The following authors have nothing to disclose: Laura Simone, Jeffrey Carter, Kathleen Moreo, Tamar Sapir No Product/Research Disclosure Information