The feasibility of an innovative GP-physiotherapist partnership to identify and manage chronic obstructive pulmonary disease (INTEGRATED): study protocol

Lisa Pagano,Stephen Crone,Deborah Pallavicini,Nicholas Zwar,Sarah Dennis,Zoe Mckeough,Sally Wootton,Sriram Mahadev,Andrew S L Chan

doi:10.1186/s40814-020-00680-4

Abstract

BackgroundChronic obstructive pulmonary disease (COPD) contributes significantly to mortality, hospitalisations and health care costs worldwide. There is evidence that the detection, accurate diagnosis and management of COPD are currently suboptimal in primary care. Physiotherapists are well-trained in cardiorespiratory management and chronic care but are currently underutilised in primary care. A cardiorespiratory physiotherapist working in partnership with general practitioners (GPs) has the potential to improve quality of care for people with COPD.MethodsA prospective pilot study will test the feasibility of an integrated model of care between GPs and physiotherapists to improve the diagnosis and management of people with COPD in primary care. Four general practices will be selected to work in partnership with four physiotherapists from their local health district. Patients at risk of developing COPD or those with a current diagnosis of COPD will be invited to attend a baseline assessment with the physiotherapist, including pre- and post-bronchodilator spirometry to identify new cases of COPD or confirm a current diagnosis and stage of COPD. The intervention for those with COPD will involve the physiotherapist and GP working in partnership to develop and implement a care plan involving the following tailored to patient need: referral to pulmonary rehabilitation (PR), physical activity counselling, medication review, smoking cessation, review of inhaler technique and education. Process outcomes will include the number of people invited and reviewed at the practice, the proportion with a new diagnosis of COPD, the number of patients eligible and referred to PR and the number who attended PR. Patient outcomes will include changes in symptoms, physical activity levels, smoking status and self-reported exacerbations.DiscussionIf feasible, we will test the integration of physiotherapists within the primary care setting in a cluster randomised controlled trial. If the model improves health outcomes for the growing numbers of people with COPD, then it may provide a GP-physiotherapist model of care that could be tested for other chronic conditions.Trial registrationANZCTR, ACTRN12619001127190. Registered on 12 August 2019—retrospectively registered.

Highlights

Chronic obstructive pulmonary disease (COPD) contributes significantly to mortality, hospitalisations and health care costs worldwide
The INTEGRATED study hypothesises that a general practitioners (GPs) and physiotherapist model of care will be a feasible and acceptable way to improve the diagnosis and management of people with COPD. This will be achieved through more accurate spirometry interpretation, at least 90% of participants who meet the COPD-X guidelines for referral to pulmonary rehabilitation (PR) being referred to a programme, an increase in physical activity levels by participants at 3 months compared to baseline, and at least 50–75% of participants have attended or commenced a smoking cessation programme at 3 months after their baseline visit
We anticipate that the GP and physiotherapist partnership will be feasible and will improve the diagnosis and management of COPD in primary care in the participating practices

Summary

Methods

The INTEGRATED study is a before and after feasibility study within the ‘health services’ research domain with the aim of trialling a new model of care intended for use in a larger cluster randomised controlled trial (RCT). The second workshop will include training on COPD management such as smoking cessation advice and referral, physical activity advice and referral to pulmonary rehabilitation if required, preparation of a care plan with the general practice team and the processes for the case-finding and follow-up appointments. Patients will be referred to PR if they meet the requirement according to the COPD-X guidelines [5] and receive participant education booklets regarding physical activity guidelines, smoking cessation and COPD management. Those without COPD on spirometry Physical activity advice and counselling using the 5 A’s approach will be provided according to the Australian Physical Activity and Sedentary Behaviour Guidelines [45]. The patient transcripts will be coded thematically and triangulated with the health professional data

Discussion

Background

Findings