Evaluation of a tailored implementation strategy to improve the management of patients with chronic obstructive pulmonary disease in primary care: a study protocol of a cluster randomized trial.
BACKGROUND
Chronic obstructive pulmonary disease (COPD) remains a major health problem, strongly related to smoking. Despite the publication of practice guidelines on prevention and treatment, not all patients with the disease receive the recommended healthcare, particularly with regard to smoking cessation advice where applicable. We have developed a tailored implementation strategy for enhancing general practitioners' adherence to the disease management guidelines. The primary aim of the study is to evaluate the effects of this tailored implementation intervention on general practitioners' adherence to guidelines.


METHODS
A pragmatic two-arm cluster randomized trial has been planned to compare care following the implementation of tailored interventions of four recommendations in COPD patients against usual care. The study will involve 18 general practices (9 in the intervention group and 9 in the control group) in Poland, each with at least 80 identified (at the baseline) patients with diagnosed COPD. The nine control practices will provide usual care without any interventions. Tailored interventions to implement four recommendations will be delivered in the remaining nine practices. At follow-up after nine months, data will be collected for all 18 general practices. The primary outcome measure is physicians' adherence to all four recommendations: brief anti-smoking advice, dyspnea assessment, care checklist utilization and demonstration to patients of correct inhaler use. This measurement will be based on data extracted from identified patients' records. Additionally, we will survey and interview patients with chronic obstructive pulmonary disease about the process of care.


CONCLUSIONS
The results of this trial will be directly applicable to primary care in Poland and add to the growing body of evidence on interventions to improve chronic illness care.


BACKGROUND
This trial has been registered with Clinical Trials Protocol Registration System.


BACKGROUND
NCT01893476.
Centre for Family and Community Medicine, Medical University of Lodz, 20 Kopcinskiego Street, Lodz 90-153, Poland. maciej.godycki-cwirko@umed.lodz.pl.
Maciek
M
Godycki-Cwirko
Izabela
I
Zakowska
Katarzyna
K
Kosiek
Michel
M
Wensing
Jaroslaw
J
Krawczyk
Anna
A
Kowalczyk
D057189:Checklist / Q000592:standards; D002985:Clinical Protocols; D004417:Dyspnea / Q000209:etiology / Q000628:therapy; D058005:General Practitioners / Q000592:standards*; D019983:Guideline Adherence / Q000592:standards; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D009330:Nebulizers and Vaporizers; D010353:Patient Education as Topic / Q000592:standards; D011044:Poland; D017410:Practice Guidelines as Topic / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D058996:Quality Improvement / Q000592:standards; D019984:Quality Indicators, Health Care / Q000592:standards; D012107:Research Design; D016540:Smoking Cessation; D013997:Time Factors; D016896:Treatment Outcome