COPD management: trial to address deficiencies in primary care

A Cochrane Review has highlighted an urgent need to identify the best type of interventions to improve guideline-recommended management of chronic obstructive pulmonary disease (COPD) and enhance patient-related outcomes in the primary care setting.

Researchers from Monash University reviewed all available studies up until May 2021 and found that current models of educational interventions for health professionals in primary care are not working, and new approaches are needed.

Interventions and outcomes

In this review, the researchers included randomised controlled trials or studies of similar design that studied educational interventions aimed at any health professionals involved in COPD management in primary care. A range of simple-to-complex interventions were used across the studies, including education provided to health professionals via sessions, workshops or online modules, provision of practice support tools or tool kits, provision of COPD clinical practice guidelines and training on lung function tests.

First author, Dr Amanda Cross, who sits within Monash’s Centre for Medicine Use and Safety (CMUS), said, “There was little-to-no evidence that educational interventions for health professionals improved COPD management, including proportion of cases diagnosed with spirometry, proportion of patients who participate in pulmonary rehabilitation or the proportion of patients prescribed guideline-recommended COPD respiratory medications.

“Interventions and outcomes varied greatly among the studies and there were a number of limitations in the design and reporting of the studies included which affected the overall quality of the evidence.”

Professor Michael Abramson, an expert in COPD from the Monash School of Public Health and Preventive Medicine, said, “Based on this review, we have concluded that further high-quality studies are necessary to determine the effectiveness of educational interventions for health professionals managing COPD in primary care, to help improve outcomes for those impacted by COPD.”

TERRACOTTA trial

Senior author of the review and member of the Lung Foundation Australia’s COPD guidelines committee, Dr Johnson George of CMUS, is leading a new cluster randomised controlled trial to address some of the deficiencies in primary care relating to COPD management.

“COPD is not only a complex condition, but also a heterogeneous condition and needs a personalised medicine approach,” he said.

The ‘Targeting Treatable Traits in COPD to Prevent Hospitalisations’ (TERRACOTTA) trial will be the first of its kind offering tailored interventions targeting treatable traits in COPD for individuals at risk of exacerbations, to improve quality of life and avoid hospitalisations.

Treatable traits refers to individually assessing patients for a specified set of treatable problems, followed by the development and implementation of an individualised treatment program. Primary care is ideally placed to deliver individualised preventive interventions and initiate early management targeting treatable traits.

A national rollout

George said that the findings from the trial will inform clinical practice and facilitate continuous quality improvement in COPD: “COPD was the top cause of preventable hospitalisations for chronic diseases in Australia in 2016–19. Our trial aims to demonstrate the efficacy of a coordinated intervention targeting treatable traits in moderate-severe COPD patients in general practice for improving health-related quality of life and reducing hospitalisations/emergency department visits.

“TERRACOTTA will focus on a national rollout of the interdisciplinary model of care, to inform its scale-up as a routine service,” said George.

The TERRACOTTA randomised controlled trial has been funded by the GSK investigator-initiated scheme. The trial has received ethics approval and is soon to commence patient recruitment.

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