Innovative health professional partnerships in primary care to improve the diagnosis and management of COPD

Background: The aim of this thesis was to determine the effectiveness and acceptability of a novel general practitioner (GP):physiotherapist partnership in primary care in the early identification and management of COPD.
Methods: Four general practices in Sydney, Australia were recruited. ‘At risk’ participants (aged >40 years, current/ex-smoker) and people with ‘existing’ COPD were invited to attend an assessment with an experienced cardiorespiratory physiotherapist at the practice. Pre/post-bronchodilator spirometry was performed to identify or confirm a diagnosis of COPD (FEV1/FVCResults: 148 participants attended a baseline assessment (117 ‘at risk’, 31 ’existing’ COPD) from 748 people invited. Obstruction was confirmed in 17% of ‘at risk’ and 77% of ‘existing’ COPD. 31 participants with airflow obstruction (mean age 75yrs (SD 9.3), mean FEV1% pred=74% (SD 7.9), 61% female) received the intervention. Following the intervention, 78% (21/27) eligible participants were referred to PR. During the interviews, all clinicians acknowledged that evidence-based practice (EBP) was enhanced and the physiotherapists knowledge and skills was able to complement the management of the GPs. Logistical issues and resources were seen as key barriers to successful implementation.
Conclusions: Results suggest that this model was effective in implementing some aspects of COPD management and was acceptable to patients and clinicians, facilitating aspects of EBP.