UNC Primary Care at Clayton Steps Up to Improve COPD Care

High-quality Chronic Obstructive Pulmonary Disease (COPD) care has been a hot topic recently at UNC Primary Care at Clayton.

UNC Primary Care at Clayton Steps Up to Improve COPD Care click to enlarge Sandra Carter, LPN, Clinical Coordinator, asks Thomas Marsland, MD, MHA, to demonstrate appropriate inhaler use during PCIC Ops

By Samantha Robin, UNC Medical Student, Class of 2019

High-quality Chronic Obstructive Pulmonary Disease (COPD) care has been a hot topic recently at UNC Primary Care at Clayton. This Johnston County practice serves approximately 400 COPD patients. Managing chronic conditions has always been an important aspect of patient care at this practice, but recent initiatives have brought the quality of COPD care to a new level.

 Practice Manager, Melissa Arnold, RN, Clinical Coordinator Sandy Carter, LPN, and Samantha Robin, a UNC fourth-year medical student, worked together to identify that inhaler education presented the greatest opportunity for improvement. The team then experimented with multiple strategies to enhance patient inhaler education.

The practice previously provided instructional inhaler videos to COPD patients, but this time-consuming process proved cumbersome for both medical assistants and patients. The practice altered the process to start each COPD patient visit by asking the patient to demonstrate how they use their inhaler at home, using the practice’s placebo inhalers. From there, the medical assistants quickly identified when patients were using their inhalers incorrectly and helped patients troubleshoot, using supplemental materials (e.g. video) when necessary. This new process quickly identified usage errors and saved the medical assistants time when patients were already using their inhalers correctly.

In early July 2018 at the outset of this intervention, the practice had documented inhaler education for 13.2% of the COPD patients. The practice set a goal to increase completed inhaler education to 20% of COPD patients by August 1. After surpassing their goal with a 24.7% completion rate by August 1, the practice then increased their goal to 30% by September 1. They also successfully met this goal by achieving a 31% completion rate and have sustained the newly established inhaler education process with their COPD patients.

After the inhaler education changes were instituted, one medical assistant commented,

“I learned that most of our patients were using their inhalers incorrectly most of the time”, revealing an even greater need for inhaler education. The added piece of inhaler teach-back made for a more efficient process, more effective patient comprehension, and improved patient and medical assistant satisfaction.

Tackling inhaler education also led the practice to identify other areas of COPD care in need of improvement. medical assistants and physicians identified that patients often had difficulty affording inhaled medications, contributing to the misuse and under-use of inhalers, resulting both in ED visits and hospital admissions. Borrowing previously developed resources from the Chapel Hill Internal Medicine practice, the quality team developed pharmacy assistance packets for each physician and medical assistant. These packets described pharmacy assistance and manufacturer assistance options for these costly medications.

For next steps, the clinic looks ahead to the incorporation of the new clinic pharmacist into COPD care. Their next goals are to implement a COPD Action Plan into routine COPD care and work together with the pharmacist to continue working to improve COPD symptom control and prevent COPD exacerbation requiring ED visits or hospital admissions.