The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts

ASSESSING BARRIERS OF INTERPROFESSIONAL CARE FOR COPD IN CINCINNATI.

April L. Gochberg1, John R. Kues2, Tiffiny Diers6, Nancy C. Elder4, Ralph Panos7, Susan L. Montauk4, James R. Boex5, Sandra L. Reagan4, Stacey Frede9,3, Mary B. Vonder Meulen8, Barbara Speer2; 1Respiratory Care Services, The Christ Hospital, Cincinnati, OH; 2Center for Continuous Professional Development, University of Cincinnati, Cincinnati, OH; 3College of Pharmacy, University of Cincinnati, Cincinnati, OH; 4Family and Community Medicine, University of Cincinnati, Cincinnati, OH; 5Health Care Administration, University of Cincinnati, Cincinnati, OH; 6Internal Medicine, University of Cincinnati, Cincinnati, OH; 7Pulmonary and Critical Care, University of Cincinnati, Cincinnati, OH; 8Family Medicine Research Division, University of Cincinnati, Cincinnati, OH; 9Residency Program, Kroger Pharmacy, Dayton-Cincinnati, OH

Background: Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading cause of death in the United States and affects more than 24 million people. Appropriate management is imperative to control symptoms. Most COPD patients receive their care from primary care providers(PCP). Spirometry is recommended to assess presence and severity of disease, yet many diagnosed with COPD have never had spirometry testing. There is significant underutilization of pulmonary rehabilitation, smoking cessation counseling and referrals to pulmonologists. Methods: Focus groups including 40 healthcare providers, 24 COPD patients and 8 caregivers were convened. The interviews had a pre-determined set of topics and were recorded. Separate focus groups were recruited and conducted from family practitioners, general internists, nurse practitioners, nurses, respiratory therapists, emergency rooms physicians, pharmacists, COPD patients and their caregivers. Each group was directed by a trained facilitator. Facilitation questions were developed by Dr. Kues, reviewed by core investigators and customized for each group. Results: Each discipline had differing perceptions of each level of care. Many were unaware of the value of an outside discipline and chose not to refer due to this ignorance. Gaps in care delivery were identified in key areas of real impact to the patient including smoking cessation counseling and pulmonary rehabilitation. Beliefs ranged from “smoking cessation is not sustainable” to “I think pulmonary rehabilitation is an end-stage treatment.” There is poor communication among all healthcare providers. Spirometry is underutilized to confirm COPD. Conclusions: PCPs are not sure how to access such therapy as smoking cessation counseling and pulmonary rehabilitation. Many providers don’t want to stigmatize the patients by labeling them with COPD and opt for diagnoses of asthma or bronchitis. There is great room for improvement using a collaborative method of not only patient care but educating other disciplines about what each brings to the table. Clinical pharmacists are uniquely positioned to monitor patients who are filling prescriptions for chronic respiratory conditions and can assess compliance, adherence and knowledge gaps. Sponsored Research - Educational Grants from: Pfizer Pharmaceuticals and Boehringer Ingelheim Pharmaceuticals