Developing a Chronic Obstructive Pulmonary Disease (COPD) Case-Finding Program in an Indigent Care Clinic

Estes, Tracy

Monday, 18 November 2013

Tracy Estes, PhD, RN, FNP-BC
College of Nursing and Public Health, South University, Glen Allen, VA
Nancy Short, DrPH, MBA, RN
School of Nursing, Duke University, Durham, NC
Donna Bowser, DNP, RN, FNP-BC
Lloyd F. Moss Free Clinic, Fredericksburg, VA
Anne H. Boyle, PhD, RN
School of Nursing, Virginia Commonwealth University, Richmond, VA

Learning Objective 1: The learner will be able to identify the appropriate COPD screening criteria, recommended screening tool, and appropriate diagnostic criteria for positive screening results.

Learning Objective 2: The learner will be able to describe the rationale and the complexity of implementing a COPD case-finding program in an indigent care clinic setting.

Chronic Obstructive Pulmonary Disease (COPD) is an insidious and heterogeneous pulmonary condition characterized by a symptom cluster of cough, breathlessness, and sputum coupled with progressive airflow obstruction causing significant morbidity, mortality, and healthcare cost burden in the United States (Dijk et al., 2011; Price, Freeman, Cleland, Kaplan, & Cerasoli, 2011; Frith et al., 2011; American Lung Association, 2012). Although early recognition is imperative to initiate interventions, COPD diagnosis usually occurs later in the disease trajectory with urban and underserved areas experiencing a disproportionate lack of diagnosis and treatment (Stoloff, 2011; Lyngso et al., 2010; Duvall & Frank, 2010). The objective of this evidence-based practice project was to design, implement, and evaluate a trial COPD case-finding program based on the International Primary Care Respiratory Group Guideline recommendations at an urban, underserved, indigent care clinic (Halbert & Isonaka, 2006; Levy et al., 2006). The clinic did not screen for COPD but instead was empirically treating patients with COPD symptoms without the use of a screening tool or spirometry. The trial COPD case-finding program was a prospective, descriptive design informed by the Diffusion of Innovation Model, whereby patients (n=39) meeting screening criteria (i.e. patients 40 years of age with a history of cigarette smoking and no pulmonary disease history) completed the COPD Questionnaire and pre-post bronchodilator challenge spirometry. Patients with a diagnosis of COPD (n=4) were tracked for appropriateness of care based on the Global Initiative for Chronic Obstructive Lung Disease COPD criteria (Greenhalgh, Robert, Bate, Macfarlance, & Kyriakidou, 2005; Global Initiative for Chronic Obstructive Lung Disease, 2011). Data were analyzed using the Statistical Software Package for Social Sciences version 20. The sample was described, the epidemiological characteristics of the COPD Questionnaire were estimated, and recommendations for sustaining the COPD case-finding program as standard of care were made.

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