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A4562 - An Innovative Point of Care Tool to Implement the 2017 GOLD Report in Practice
Author Block: C. Poirier1, J. Bouchard2, M. Bhutani3, P. Hernandez4, D. Ngui5, R. Tytus6; 1Université de Montréal, Montreal, ON, Canada, 2Université Laval, La Malbaie, QC, Canada, 3University of Alberta, Edmonton, AB, Canada, 4Dalhousie University, Halifax, NS, Canada, 5University of British Columbia, Vancouver, BC, Canada, 6McMaster University, Hamilton, ON, Canada.
Rationale: Updated guidelines for the optimal treatment of chronic obstructive pulmonary disease (COPD) were outlined in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 report. The report emphasized a personalized treatment approach based on respiratory symptoms measured by the COPD Assessment Test (CAT) or modified Medical Research Council (mMRC) scale, and exacerbations alone to assign A, B, C, or D group. Further, the report introduced strategies for escalation and de-escalation of pharmacotherapy, including combination inhaler use (long-acting muscarinic antagonist [LAMA] / long-acting beta2-agonist [LABA]) and appropriate use of inhaled corticosteroid (ICS). The purpose of the present study was to assess Canadian COPD management practices and evaluate the effectiveness of the online point-of-care (PoC) tool to increase physician adherence to the GOLD 2017 recommendations. Methods: Respirologists (n = 42) and family physicians (FPs, n = 102) across Canada used Vivomap®, a Web-based application, to input COPD management practices for ten patients each (n = 1,089). The application consisted of three steps: (1) a pre-assessment survey to understand physicians’ baseline knowledge of the GOLD recommendations, (2) a patient-completed iPad form assessing CAT, mMRC, and exacerbation history, and (3) a physician-completed PoC assessment, which provided recommendations for treatment based on GOLD, reinforced by prompts triggered at treatment decision points. The patient inclusion criteria included a diagnosis of COPD, 35 years of age or older, and providing informed consent. Results: In the pre-assessment survey, physicians’ average knowledge of the GOLD recommendations was rated as 4.1/5. Despite this high score, reported CAT and mMRC usage was low (25% and 43% of physicians reported regular use, respectively) with 59% of patients having persistent symptoms. Further, physicians and patients reported different frequencies of exacerbations in 28% of cases (10% physician underestimation; 7% physician overestimation; 11% patient responded “I don’t know”). Following review of the patient assessment, 54% of physicians indicated they would change their treatment regimen to adhere to GOLD recommendations. Conclusions: Adoption of the GOLD 2017 recommendations into practice was made evident by changes in treatment regimens after use of the CAT and a review of exacerbation history. Changes in treatment included the increased use of combination inhalers in appropriate patients, and the decreased use of ICS in stable patients. This study suggests PoC feedback was effective at optimizing the treatment of Canadian COPD patients.