Patient effects following two educational methods for teaching GPs about COPD: a cluster randomized controlled trial

Aim: To compare two educational methods for GPs, regarding their effects on health-related outcomes in patients with moderate and severe COPD.Method: A pragmatic cluster randomized controlled trial with primary health care centers (PHCCs) as units of randomization was conducted. Randomly selected patients (n=542) with COPD in GOLD stages 2 and 3 from 24 PHCCs in Stockholm County, Sweden, replied to a questionnaire about their disease prior to and 18 months after a 2x2-hour CME was given to their GPs (n=255). At the CME sessions, participatory, case method (CM) learning (intervention arm) and semi-didactic, traditional lectures (control arm) were used. Patients were allocated to the study arms as their GPs, resulting in 273 (50.4%) patients in the CM learning arm and 269 (49.6%) in the traditional lectures arm. Primary outcomes were changes in the scores of Clinical COPD Questionnaire (CCQ), between baseline and 18 months. Secondary outcomes were changes in scores of other symptom assessments, acute exacerbations, smoking, and care provider visits. Statistical analyses were adjusted to the cluster design.Results: At 18 months, 425 patients (78%) completed the questionnaire. None of the patient outcomes differed between the arms. The results indicated generally a slight deteriorating of COPD. The mean total CCQ scores changed from 1.87 to 1.97 (P=0.03). More patients had visited a physiotherapist (13.2%-17.8%, P=0.04), and fewer patients smoked (28.9%-25.1%, P=0.003).Conclusions: Participatory (CM learning) and didactic (traditional lecture) teaching methods had equal effects on COPD patient outcomes, when assessed 18 months after CME sessions for GPs at PHCCs. Overall, the prevalence of smoking decreased and visits to physiotherapists increased, which may be results of CME for GPs. We also observed a slight disease progression in COPD patients over the study period, perhaps because of multimorbidity and expected disease progression. Implementation Science/Service Development Research Ideas on Respiratory Conditions and Tobacco Dependency Abstract Declaration of Interest HS: honoraria for educational activities from Boehringer Ingelheim/Novartis/AstraZeneca/TEVA; an unrestricted research grant from AstraZeneca. AN: compensation for educational activities from AstraZeneca and SM from Novartis. BS: honoraria for educational activities from AstraZeneca/Boehringer Ingelheim/Chiesi/Meda/Novartis/TEVA; advisory board compensations from AstraZeneca/Novartis/Meda/TEVA/GlaxoSmithKline/Boehringer Ingelheim. IK and SEJ: no competing interests. This work was supported by employment in and grants from the Stockholm County Council, employment in Dalarna County Council, and an unrestricted research grant from AstraZeneca Inc. The pharmaceutical industry did not participate in any part of the study, and the participants were not offered any financial incentives. Trial registration: Clinicaltrials.gov, 10 August 2014, Identifier NCT02213809. References and Clinical Trial Registry Information