Respiratory Therapist Case Managers Integrated Into COPD Clinic Care Improve Symptomology and Exacerbation Rates

Abstract

Background:

Personalized education and careful selection of treatments can improve health behaviors and outcomes in patients with COPD. However, many COPD patients have incomplete knowledge of their disease. Lack of understanding has direct effects on patient care; inefficient inhaler technique remains prevalent and leads to undertreated symptoms. We hypothesized that an interdisciplinary care approach to COPD, with integrated RRTs in COPD clinic, will improve COPD care as measured by improved CAT scores, exacerbation rates, and COPD-related hospitalizations.

Methods:

Retrospective analysis of 241 patients enrolled in the UC Davis Comprehensive COPD Clinic registry (IRB approved). Of 241 patients, 101 had follow-up 12 months post COPD clinic visit. Two patients were excluded from analysis due to discrepancies in CAT assessments by differing family member input and dementia barriers, leaving 99 patients. The clinic RRT assessed smoking status, diagnostic testing, symptom burden, and whether prior education had been provided. Patients received disease-specific education, training on inhaled regimens, referrals to pulmonary rehabilitation, assistance with durable medical equipment, and subsequent access to RRTs. We collected CAT scores at initial clinic visit and 2-month follow up visit, exacerbation rates that required a corticosteroid and/or an antibiotic and those that required hospitalization in the 12 months prior to and after the initial COPD clinic visit. Descriptive statistical analysis was performed with paired t-test and 95% confidence intervals when appropriate.

Results:

Mean CAT score of 20.80 and follow up CAT mean of 18.47 (1.16, 3.40 95% CI, P = .0002). There were 115 exacerbations in the 12-month period prior to the initial clinic visit and 63 exacerbations in the 12 months post clinic visit (P = .006). In the 12-month period prior to the clinic visit there were 44 hospital admissions for COPD exacerbations and 20 hospital admissions for a COPD exacerbation in the 12 months post clinic visit (P = .06).

Conclusions:

Our limited retrospective study demonstrated that individualized patient care in a COPD clinic with an integrated RRT was associated with significant improvements in CAT score and exacerbation rates, but not statistically significant in exacerbations leading to hospitalizations. Our study is limited by confounding of multiple interventions and no control cohort without RRT involvement but suggests an RRT-centered intensive program may improve meaningful outcomes.