attempt to address deficits 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 to improve patient-related outcomes in the primary care setting.

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

Interventions and outcomes

In this review, the researchers included randomized controlled trials or studies of similar design that studied educational interventions targeting all health professionals involved in COPD management in primary care. A variety of simple to complex interventions were used in the studies, including education offered to health professionals through sessions, workshops or online modules, provision of practice support tools or tools, provision of COPD clinical practice guidelines and training on lung function tests.

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

“Interventions and outcomes differed strongly among the studies and there were a number of limitations in the design and reporting of the studies that 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 needed to determine the effectiveness of educational interventions for health professionals who Manage COPD in primary care, to help improve outcomes for those affected by COPD.


Senior author of the review and member of the COPD Guidelines Committee of the Lung Foundation Australia, Dr Johnson George of CMUS, is leading a new cluster randomized controlled trial to address some of the shortcomings in primary care related to COPD management.

“COPD is not only a complex condition but also a heterogeneous condition and requires a personalized approach to medication,” he said.

The ‘Targeting Treatable Traits in COPD to Prevent Hospitalizations’ (TERRACOTTA) trial will be the first of its kind to offer tailor-made interventions aimed at treating traits in COPD for individuals at risk of exacerbations, in order to improve the quality of life and prevent hospitalizations.

Treatable characteristics refer to the individual assessment of patients for a specified set of treatment problems, followed by the development and implementation of an individualized treatment program. Primary care is ideally placed to deliver individualized preventive interventions and initiate early management focused on treatment characteristics.

A nationwide outreach

George said the trial findings would inform clinical practice and facilitate continuous quality improvement in COPD: “COPD was the leading cause of pre-existing chronic diseases in Australia in 2016-19. Our trial aims to demonstrate its effectiveness of a coordinated intervention aimed at treating traits in moderately-severe COPD patients in general practice to improve health-related quality of life and reduce hospitalizations / visits to emergency departments.

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

The TERRACOTTA randomized controlled trial is funded by the GSK researcher-initiated scheme. The trial has received ethics approval and will soon begin recruiting patients.

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attempt to address deficits in primary care

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