A2276 - Chronic Obstructive Pulmonary Disease Assessment in Primary Care to Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE): Multi-Method Qualitative Findings Support Implementation Readiness of a New COPD Screening Tool in Primary Care Practice
Author Block: R. Brown¹, S. Isaac¹, H. Tapp², R. Dolor³, L. Knox⁴, L. Zittleman⁵, N. Elder⁶, B. J. Make⁷, B. P. Yawn⁸, M. K. Han⁹, F. Martinez¹⁰; ¹School of Public Health, University of Michigan, Ann Arbor, MI, United States, ²Research Family Medicine, Atrium Health, Charlotte, NC, United States, ³Duke General Internal Medicine, Durham, NC, United States, ⁴LANet, Los Angeles, CA, United States, ⁵High Plains Research Network, Aurora, CO, United States, ⁶Oregon Rural Practice-based Research Network, Portland, OR, United States, ⁷Natl Jewish Health, Denver, CO, United States, ⁸COPD foundation, Miami, FL, United States, ⁹University of Michigan School of Medicine, Ann Arbor, MI, United States, ¹⁰Weill Cornell Medicine, New York City, NY, United States.
Rationale: Enhancing COPD management should include optimal disease recognition at the primary care level. As effective COPD diagnosis may involve all levels of primary care clinic staff, the CAPTURE validation study included workflow reviews, patient opinion surveys, staff questionnaires, clinician focus groups and case-based vignettes to cohesively form a robust real-world practice assessment of COPD case-finding readiness. We employed this multi-method qualitative sub-aim approach to guide CAPTURE’s longitudinal quantitative assessments and to inform strategies for practice implementation of the CAPTURE tool after study completion.Methods: 196 adults without diagnosis of COPD from 82 US practices; and, 114 primary care clinic staff evenly enrolled in the CAPTURE study from 7 US practice-based research networks (PBRNs) that serve rural and urban locales. Site-specific practice information, clinician questionnaires, and patient responses populated focus group themes. Analyses of clinician and patient responses including frequencies and correlations by clinician level and practice were assessed. 10 practices participated in clinician focus groups that investigated salience, patterning, and contexts of key discourse items. Responses were assigned a priori codes as relevant for CAPTURE implementation planning, COPD diagnosis, CAPTURE intra-office clinical communication, and COPD and CAPTURE education preference, as well as COPD assessment options before and after the COVID-19 pandemic.
Results: Patients strongly agreed (>90%) the CAPTURE tool was easy to read and understand, without response difference to questions via verbal versus written administration. Despite lack of COPD staff knowledge reflecting known national primary care education need, clinicians agreed (> 90%) the CAPTURE tool would aid COPD case-finding and aligned with patients (>90%) that CAPTURE could be implemented and completed as part of routine health screening within 5 minutes. Despite most clinicians reporting a lack of reliable on-site pulmonary function capability, physicians, nurses, nurse practitioners, physician assistants, medical assistants uniformly strongly agreed (>90%) that the peak flow testing (PEF) component of CAPTURE could aid respiratory assessment. All practices agreed they’d consider alternate PEF strategies as part of in-person or telehealth assessments if pandemic public health concerns persisted.
Conclusions: Thorough qualitative review of CAPTURE in primary care practice demonstrates readiness for this COPD case-finding tool’s implementation into US primary care. With CAPTURE operating characteristic validation underway among 5000 patients in practices with wide demographic and geographic variability, this qualitative methodology 1) offered critical in-study information guiding protocol adjustment impacted by unforeseen events (e.g. the COVID crisis); and, 2) clearly outlined COPD diagnosis processes preferred for real-world primary care use.
Figure 1.