Dataset Information

Primary Care Provider Experience With Proactive E-Consults to Improve COPD Outcomes and Access to Specialty Care.

ABSTRACT:

Background

Often patients with chronic obstructive pulmonary disease (COPD) receive poor quality care with limited access to pulmonologists. We tested a novel intervention, INtegrating Care After Exacerbation of COPD (InCasE), that improved patient outcomes after hospitalization for COPD. InCasE used population-based identification of patients for proactive e-consultation by pulmonologists, and tailored recommendations with pre-populated orders timed to follow-up with primary care providers (PCPs). Although adoption by PCPs was high, we do not know how PCPs experienced the intervention.

Objective

Our objective was to assess PCPs' experience with proactive pulmonary e-consults after hospitalization for COPD.

Methods

We conducted a convergent mixed methods study among study PCPs at 2 medical centers and 10 outpatient clinics. PCPs underwent semi-structured interviews and surveys. We performed descriptive analyses on quantitative data and inductive and deductive coding based on prespecified themes of acceptability, appropriateness, and feasibility for qualitative data.

Key results

We conducted 10 interviews and 37 PCPs completed surveys. PCPs perceived InCasE to be acceptable and feasible. Facilitators included the proactive consult approach to patient identification and order entry. PCPs also noted the intervention was respectful and collegial. PCPs had concerns regarding appropriateness related to an unclear role in communicating recommendations to patients. PCPs also noted a potential decrease in autonomy if overused.

Conclusion

This evaluation indicates that a proactive e-consult intervention can be deployed to collaboratively manage the health of populations with COPD in a way that is acceptable, appropriate, and feasible for primary care. Lessons learned from this study suggest the intervention may be transferable to other settings and specialties.

SUBMITTER: Spece LJ

PROVIDER: S-EPMC9995235 | biostudies-literature | 2023 Jan

REPOSITORIES: biostudies-literature

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Publications

Primary Care Provider Experience With Proactive E-Consults to Improve COPD Outcomes and Access to Specialty Care.

Spece Laura J LJ Weppner William G WG Weiner Bryan J BJ Collins Margaret M Adamson Rosemary R Berger Douglas B DB Nelson Karin M KM McDowell Jennifer J Epler Eric E Carvalho Paula G PG Woo Deborah M DM Donovan Lucas M LM Feemster Laura C LC Au David H DH Au David H DH Sayre George G

Chronic obstructive pulmonary diseases (Miami, Fla.) 20230101 1

<h4>Background</h4>Often patients with chronic obstructive pulmonary disease (COPD) receive poor quality care with limited access to pulmonologists. We tested a novel intervention, INtegrating Care After Exacerbation of COPD (InCasE), that improved patient outcomes after hospitalization for COPD. InCasE used population-based identification of patients for proactive e-consultation by pulmonologists, and tailored recommendations with pre-populated orders timed to follow-up with primary care provid ...[more]

PMID: 36472622

Similar Datasets

Project description:RationaleLarge gaps exist between guideline-recommended outpatient chronic obstructive pulmonary disease (COPD) care and clinical practice. Seeking to design effective interventions, we identified patient and primary care provider (PCP) characteristics associated with receiving evidence-based COPD care.MethodsWe performed an observational study of adults aged ≥ 40 years with clinically diagnosed COPD who received care at 2 University of Washington-affiliated primary care clinics between June 1, 2011, and June 1, 2013. Our primary outcome was the proportion of evidence-based outpatient COPD quality measures received through primary or pulmonary care. Among all patients, we assessed spirometry completion, respiratory symptom identification, smoking status ascertainment, oxygen saturation measurement, and guideline-concordant inhaled therapy prescription. We also determined confirmation of airflow obstruction, oxygen prescription, smoking cessation intervention, and pulmonary rehabilitation referral if eligible. We used multivariable mixed effects linear regression to estimate the association of patient and PCP characteristics with the primary outcome.ResultsAmong 641 patients, 382 were male (59.6%) with mean age 63.6 (standard deviation [SD] 10.6) years. Most patients currently smoked (N=386, 60.2%). Patients saw 150 unique PCPs during 5.3 (SD 3.2) PCP visits, with 107 completing pulmonary referrals (16.7%). Patients received 67.5% (SD 18.4%) of eligible (median 7 [interquartile range 6-7]) evidence-based quality measures. After adjustment, pulmonary referral was associated with a higher receipt of outpatient quality measures (ß117.7%, 95% confidence interval: 12.6%, 22.7%). Patient demographics, comorbidities, and PCP identity/characteristics were not associated with outpatient care quality.ConclusionsThe quality of outpatient COPD care was suboptimal. Future studies should investigate if engaging pulmonologists in COPD management improves care quality.

Dataset Information

Primary Care Provider Experience With Proactive E-Consults to Improve COPD Outcomes and Access to Specialty Care.

Background

Objective

Methods

Key results

Conclusion

Publications

Primary Care Provider Experience With Proactive E-Consults to Improve COPD Outcomes and Access to Specialty Care.

Similar Datasets

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