Translating The GOLD COPD Guidelines Into Primary Care Practice

This project will evaluate the translation of the GOLD (the Global Strategy for the
Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease) COPD
guidelines into primary care practice. This study is based upon the premise that an
informed, activated patient will interact with a prepared, proactive team to improve
appropriate COPD screening, diagnosis and management. During phase I, a needs assessment
will evaluate barriers and facilitators to implementation of COPD guidelines into clinical
practice through focus groups of primary care patients and providers. Using formative
evaluation and feedback from the focus groups, three tools will be developed, refined and
pilot tested. These include: a computerized patient activation tool that will be used by the
patient either in the waiting room or in the examination room; a web-based, interactive COPD
guidelines tool to be used by primary care providers as a decision support tool at the point
of care and a COPD patient education toolbox to be used by the practice team. During phase
II, a block, randomized design cluster trial will be performed with one year of intervention
within non-academic primary care practices (30 practices) throughout the state of Rhode
Island and southeastern MA. The effectiveness of the materials developed in phase I will be
tested in phase II regarding physician performance of COPD guideline implementation and the
improvement in the clinically relevant outcomes (appropriate screening, diagnosis and
management of COPD) compared to usual care. The investigators will also examine the use of a
patient activation tool -'MyLungAge' to prompt patients to talk with their health care
provider regarding their lung health and risk for COPD. Products for dissemination from this
grant will include the results of the focus groups barriers and facilitators to
implementation and adherence to COPD guidelines, a computerized data collection module for
quality of care assessment regarding COPD guidelines, a refined computerized patient
activation tool, an enhanced web-based COPD interactive guideline tool, tailored academic
detailing materials, and the results of the randomized clinical trial on the effectiveness
of these tools to improve COPD guideline adherence in primary care practice.

Inclusion Criteria:

- All patients 40 years or older

- Seen at least once in the past 2 years (active patients) by their PCP

- And/or 40 years of age and less than 81 years of age who smoke.

Exclusion Criteria:

- < 40 years of age