Patient outcomes following GPs\u2019 educations about COPD: a cluster randomized controlled trial

Hanna Sandelowsky,Anna Nager,Sven-Erik Johansson,Björn Ställberg,Sonja Modin,Ingvar Krakau

doi:10.1038/s41533-020-00204-w

Abstract

This study aimed to compare patient outcomes following case method learning and traditional lectures as methods for continuing medical education (CME) about chronic obstructive pulmonary disease (COPD) for general practitioners (GPs) in Sweden. In a pragmatic cluster randomized controlled trial, COPD patients (n = 425; case method group n = 209, traditional lectures group n = 216) from 24 primary health care centers replied to questionnaires prior to and 18 months after a 2 × 2-h CME was given to GPs (n = 255). We measured changes in the scores of the Clinical COPD Questionnaire (CCQ), symptoms, needs for disease information, exacerbations, smoking, and use of pulmonary rehabilitation. The changes over time were similar for both CME methods. Patients who had used pulmonary rehabilitation increased from 13.2 to 17.8% (P = 0.04), and prevalence of smoking decreased from 28.9 to 25.1% (P = 0.003). In conclusion, neither of the used CME methods was superior than the other regarding patient outcomes. CME’s primary value may lay in improving GPs’ adherence to guidelines, which should lead to long-term positive changes in patient health.

Highlights

Chronic obstructive pulmonary disease (COPD) is a public health burden that causes suffering and mortality
The current treatment recommendations for patients with moderate to severe COPD are based on both non-pharmacological treatments and pharmacological treatments
The nonresponders at baseline were slightly younger than the responders and more of them were in Global Initiative for Obstructive Lung Disease (GOLD) stage 2 (68% vs. 57%, P = 0.001)

Summary

Introduction

Chronic obstructive pulmonary disease (COPD) is a public health burden that causes suffering and mortality. The Global Initiative for Obstructive Lung Disease (GOLD) guidelines aim to improve quality of life and prognosis by recommending treatments to reduce symptoms and prevent exacerbations[1]. The current treatment recommendations for patients with moderate to severe COPD are based on both non-pharmacological treatments (e.g., smoking cessation, pulmonary rehabilitation, and nutritional therapy) and pharmacological treatments. Assessments of disease progress and therapeutic choices are mainly made by monitoring the development of symptoms and exacerbations. Optimal COPD care can best be delivered via person-centered care given by interprofessional teams. In Sweden, the majority of patients with COPD are managed in primary health care. As elsewhere, there is a continuing need for improvements in general practitioners’ (GPs) adherence to guidelines[2]

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Conclusion