Clinical Problem Online Tutoring

Annotated bibliography for Clinical Problem health

Introduction

Physicians’ lack of engagement in smoking cessation treatment leads to ineffective treatment of COPD patients resulting in numerous relapse. Almost every healthcare institution that provides COPD care employs interactive multidisciplinary care because it is long term. COPD often coexists with multiple psychosocial, psychological, and medical concerns. Van Eerd et al. (2017) illustrate the negative impacts of physicians’ lack of engagement in COPD care as creating a loophole in the healthcare delivery system, which will ultimately affect it negatively. This provides insights to physicians, other healthcare providers, and instructions about the importance of addressing factors that affect them or their providers in a more meaningful way to promote the achievement of the intended objective, which is quality and equal care to all patients.

Annotated bibliography

Mansoor, S., Obaida, Z., Ballowe, L., Campbell, A. R., Patrie, J. T., Byrum, T. D., & Shim, Y. M. (2020). Clinical impact of multidisciplinary outpatient care on outcomes of patients with COPD. International Journal of Chronic Obstructive Pulmonary Disease, 15, 33.
Mansoor et al. (2020) used a quantitative study to show that integrative multidisciplinary disease management (IMDM) leads to maximum clinical benefits to COPD patients. Mansoor and colleagues argued that COPD is heterogeneous and requires a combination of pharmacologic and non-pharmacological interventions recommending that it be comprehensively addressed.. Mansoor et al. (2020) illustrate that most healthcare settings have inconsistently applied IMDM, thus significantly impacting COPD care.
This was a retrospective observational cohort study carried out in a single-center, University of Virginia COPD clinic. The study involved 124 patients with pre-existing COPD diagnoses who were randomly selected into the study. They were administered IMDM consisting of physicians, COPD nurses, and a respiratory therapist. This team evaluated COPD patients’ compliance with treatments, objective and subjective respiratory parameters, and other variables during the follow-ups. The researchers administered similar IMDM during follow up visits aiming to address the deficiency as was appropriate. The study results showed a decline in all elements of the BODE score in the worst group, a notable change in the modified medical research council dyspnea scale with preserved spirometry values in the improved group, and a 13% reduction in the incidence of smoking cigarettes during the follow-ups. These findings adequately answered the study objective.
One of the study’s strengths is the commitment to warrant effective and persistent patient education at every level of care, which is an essential part of the IMDM which adequately promoted IMDM intervention and led to an increased desired outcome. Unfortunately, the sample size was small, making the generalization of findings difficult. Besides, the study was a single-arm without control or placebo, which could have enhanced the quality of the study findings. Overall, the study provides insights concerning the health benefits of a multidisciplinary approach to managing COPD.
Van Eerd, E., Risor, M., Spigt, M., Godycki-Cwirko, M., Andreeva, E., Francis, N., …Kotz, D. (2017). Why do physicians lack engagement with smoking cessation treatment in their COPD patients? A multinational qualitative study. npj Primary Care Respiratory Medicine, 27(41), 1-6.doi: 10.1038/s41533-017-0038-6
Van Eerd et al. (2017) used qualitative research to explain why doctors do not often administer evidence-based smoking cessation management to their COPD patients. Van Eerd and colleagues aimed to understand how doctors participated in the smoking cessation treatment for their COPD patients by analyzing their opinions and the difficulties they encountered as they care for such patients. These researchers argue that physicians lacked commitment to smoking cessation treatment among COPD patients despite having a vital task in administering adequate smoking cessation treatments to COPD patients.
The study involved 21 focus group discussions consisting of general practitioners and pulmonologists in seven counties in Europe and Asia. The researchers then created three themes, including physicians’ frustrations with COPD patients, physicians’ lack of adequate knowledge and adverse beliefs about most smoking cessation treatments, and organization factors that affected the maximum exploitation of the smoking cessation treatments. These physicians were randomly selected into these focus discussion groups. The study found that physicians’ frustration, lack of adequate knowledge, and negative beliefs about smoking cessation treatment significantly affected evidence-based care for COPD patients who smoked and led to unequal care delivery. These findings firmly answer why physicians are reluctant to engage in smoking cessation treatment.
The study had notable strengths. Firstly, it had inputs from physicians from seven different nations, which means the physician-related barriers to evidence-based care to COPD patients who smoke seem an urgent global concern. Unfortunately, the study had a limitation. It did not specify the role that each of these stated health contexts played in leading to the stated concerns. Overall, understanding factors that lead to physician reduced engagement in smoking cessation treatment provides insights helping in addressing most of these factors to enhance the quality and safety of COPD care.

Wu, C. X., Hwang, C. H., Tan, W. S., Tai, K. P., Kwek, L. S. L., Chee, T. G., … & Chua, G. S. W. (2018). Effectiveness of a chronic obstructive pulmonary disease integrated care pathway in a regional health system: a propensity score-matched cohort study. BMJ Open, 8(3), e019425.
Wu et al. (2018) used a quantitative study to evaluate the effectiveness of COPD integrated care pathway (COPD-ICP) programs to COPD patients in terms of reducing incidences of hospitalizations and length of hospitalization. They argued that COPD-ICP programs enhance the overall management of COPD and improve the quality of COPD patients’ lives, especially among those whose COPD is partly controlled or uncontrolled, decrease the risk of COPD-related hospitalizations and help the country reduce the cost of healthcare utilization.
The study employed a retrospective propensity score-matched cohort study design and obtained data from the COPD registry managed by three regional health systems in Singapore. Ninety-two patients were enrolled in the program and divided into four groups. The control group was 92 non-enrollees obtained through matching method but had specialist outpatient clinic records and were in the COPD registry. The researchers gathered data one year before enrollment and then carried follow up activities for two years, three months interval for enrollees, and two years for the control group. The study revealed that COPD-ICP program enrollees had a lower risk of COPD hospitalization and length of hospitalization than the control. Besides, enrollees had improved compliance with all recommendations regarding COPD care compared to non-enrollees. These study findings reveal the effectiveness of the COPD-ICP program in the management of COPD patients.
The study had some strength. The researchers’ choice to use the matched method to identify the non-enrollees utilizing the propensity scores helped ensure a balance in baseline features between the enrollees and non-enrollees. It decreased the impact of selection bias. Unfortunately, Wu et al. (2018) did not conduct a randomized trial; therefore, there is a possibility that enrollees were different from those of non-enrollees because a lack of randomization could have influenced the study results. Overall, the study provides essential insights to healthcare professionals and institutions regarding the effectiveness of integrated multidisciplinary care approach to COPD patients.
Polosa, R., Morjaria, J. B., Prosperini, U., Russo, C., Pennisi, A., Puleo, R., … & Caponnetto, P. (2018). Health effects in COPD smokers who switch to electronic cigarettes: a retrospective-prospective 3-year follow-up. International journal of chronic obstructive pulmonary disease, 13, 2533.
Polosa et al. (2018) employed a quantitative study to show numerous health benefits of electronic cigarettes to COPD patients by analyzing the respiratory parameters of a cohort of chronic obstructive pulmonary disease patients. Polosa and colleagues argued combustion-free nicotine tools (electronic smoking) do not expose COPD patients to harmful nicotine, unlike nicotine replacement therapy.
This was a retrospective prospective cohort study involving 48 COPD patients, electronic cigarette users, and matched smoking COPD patients non-electronic cigarette users as control randomly assigned to the study. The COPD patients from both EC users and the control group were followed for two years and then prospectively followed up for 12 months. In the first two years, researchers reviewed patients’ notes at baseline when EC users first used EC, after one year (first visit) and two years to confirm the subjective and objective respiratory parameters obtained in the first visit. The prospective study involved following patients in both groups for one year and re-evaluating their subjective and objective respiratory parameters at the end of the year. The study results showed that electronic cigarette is effective at enhancing objective and subjective chronic obstructive pulmonary disease outcomes. It may result in long term benefits, and effective at reversing the majority of the harms attributed to tobacco smoking among COPD patients. These study findings adequately answered the study’s aim.
Polosa et al. (2018) had numerous strengths; however, one that stood out was the provision of insights about the benefits of EC use instead of nicotine replacement therapy, which has been recommended for a long time. Regrettably, the study does not describe measures that were ensured to warrant that EC users did not smoke when at their homes, which means that some EC users might have smoked cigarettes. Overall, these findings are not only an addition of essential information in the management of COPD. But it is also crucial to help healthcare workers recognize the best ways to help patients abstain from tobacco smoking.

Conclusion

Two of the four articles focused on a multidisciplinary approach to managing COPD patients. Mansoor et al. (2020) and Wu et al. (2018) show that an integrative multidisciplinary care approach to management COPD significantly reduces COPD-related hospitalizations, length of hospital stay increase compliance with measures and morbidities.
Van Eerd et al. (2017) attribute physicians’ lack of engagement in smoking cessation treatments to patient-related, physician-related, and organization-related factors. However, the study shows that most physicians are vastly affected by the unappealing responses and behaviors of COPD patients leading to the development of negative feelings towards their care. Polosa et al. (2018) recommend that if healthcare providers can administer electronic cigarettes, which are a combustion-free nicotine remedy, most of the patient-related factors as the show will be addressed.
COPD is a chronic disease requiring long term care, which all these articles support. Therefore, every factor that seems to affect integrated multidisciplinary care delivery to COPD patients should be addressed urgently.