Barbara P Yawn1, Karen Duvall2, John Peabody3, Frank Albers4, Ahmar Iqbal5, Heather Paden6, Valentina B Zubek6, William C Wadland7. 1. Department of Research, Olmsted Medical Center, Rochester, Minnesota. Electronic address: byawn@olmmed.org. 2. Department of Family Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California. 3. QURE Healthcare, San Rafael, California, Glaxo SmithKline (Albers), Chapel Hill, North Carolina. 4. Department of Research, Olmsted Medical Center, Rochester, Minnesota. 5. Pfizer, Inc. (Iqbal), New York, New York. 6. Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut. 7. Department of Family Medicine, Michigan State University, East Lansing, Michigan.
Abstract
BACKGROUND:Chronic obstructive pulmonary disease (COPD) is frequently misdiagnosed or undiagnosed, which can delay disease management interventions. PURPOSE: The Screening, Evaluating and Assessing Rate CHanges of diagnosing respiratory conditions in primary care 1 (SEARCH1) study assessed whether screening using the COPD Population Screener (COPD-PS) questionnaire to detect COPD risk factors and symptoms, with or without a handheld spirometer (copd-6) to detect airflow limitation, can increase yields of COPD diagnosis and respiratory-related clinician actions in primary care. DESIGN: A prospective, multi-center, pragmatic, comparative-effectiveness, cluster-randomized study conducted from September 2010 to October 2011 (data analyzed from December 2011 to January 2013). PARTICIPANTS: Men and women aged ≥40 years visiting their participating primary care practice for any reason. INTERVENTION: Practices were randomized to three study arms: COPD-PS + copd-6, COPD-PS alone, and usual care (no interventions). No practices received any specific education about COPD or its diagnosis. MAIN OUTCOME MEASURES: The primary endpoint was yield of new clinical COPD diagnosis; the secondary endpoint was yield of respiratory-related clinician actions. RESULTS: Of 9,704 patients enrolled, 8,770 had no prior COPD diagnosis and were included in endpoint analyses. Both interventions significantly increased COPD diagnostic yield over 8 weeks. Compared with a mean yield of 0.49% (0.13%) (controls), yields were 1.07% (0.20%) (OR=2.20, 95% CI=1.26, 3.84, p=0.006) and 1.16% (0.22%) (OR=2.38, 95% CI=1.38, 4.13, p=0.002) for COPD-PS and COPD-PS+copd-6 study arms, respectively. Respiratory-related clinician actions were not significantly different across study arms. CONCLUSIONS: Office-based assessment can significantly increase COPD diagnosis by primary care physicians. Future trials must evaluate whether screening can improve outcomes for patients with COPD.
RCT Entities:
BACKGROUND:Chronic obstructive pulmonary disease (COPD) is frequently misdiagnosed or undiagnosed, which can delay disease management interventions. PURPOSE: The Screening, Evaluating and Assessing Rate CHanges of diagnosing respiratory conditions in primary care 1 (SEARCH1) study assessed whether screening using the COPD Population Screener (COPD-PS) questionnaire to detect COPD risk factors and symptoms, with or without a handheld spirometer (copd-6) to detect airflow limitation, can increase yields of COPD diagnosis and respiratory-related clinician actions in primary care. DESIGN: A prospective, multi-center, pragmatic, comparative-effectiveness, cluster-randomized study conducted from September 2010 to October 2011 (data analyzed from December 2011 to January 2013). PARTICIPANTS: Men and women aged ≥40 years visiting their participating primary care practice for any reason. INTERVENTION: Practices were randomized to three study arms: COPD-PS + copd-6, COPD-PS alone, and usual care (no interventions). No practices received any specific education about COPD or its diagnosis. MAIN OUTCOME MEASURES: The primary endpoint was yield of new clinical COPD diagnosis; the secondary endpoint was yield of respiratory-related clinician actions. RESULTS: Of 9,704 patients enrolled, 8,770 had no prior COPD diagnosis and were included in endpoint analyses. Both interventions significantly increased COPD diagnostic yield over 8 weeks. Compared with a mean yield of 0.49% (0.13%) (controls), yields were 1.07% (0.20%) (OR=2.20, 95% CI=1.26, 3.84, p=0.006) and 1.16% (0.22%) (OR=2.38, 95% CI=1.38, 4.13, p=0.002) for COPD-PS and COPD-PS+copd-6 study arms, respectively. Respiratory-related clinician actions were not significantly different across study arms. CONCLUSIONS: Office-based assessment can significantly increase COPD diagnosis by primary care physicians. Future trials must evaluate whether screening can improve outcomes for patients with COPD.
Authors: Kate M Johnson; Mohsen Sadatsafavi; Amin Adibi; Larry Lynd; Mark Harrison; Hamid Tavakoli; Don D Sin; Stirling Bryan Journal: Appl Health Econ Health Policy Date: 2020-11-02 Impact factor: 2.561
Authors: Roy A Pleasants; Khosrow Heidari; Anne G Wheaton; Jill A Ohar; Charlie Strange; Janet B Croft; Winston Liao; David M Mannino; Monica Kraft Journal: COPD Date: 2015-09-14 Impact factor: 2.409