Improving Primary Care Providers’ Degree of Comfort in Clinical Decision Making When Caring for Patients with COPD with the Use of an Evidence-Based Practice Tool

Written by Davina A. Soernssen

doi: https://doi.org/10.13178/jnparr.2020.10.01.1005

Abstract

Background: This practice improvement project sought to increase the comfort level of primary care providers’ (PCPs) clinical decision making when assessing the patient with chronic obstructive pulmonary disease (COPD) through the use of an instructional session reviewing the evidence-based guidelines and combined assessment tool of the 2018 Global Initiative for Chronic Obstructive Lung Disease (GOLD).

Objective: A mixed quantitative, qualitative, and pretest-posttest design was used to examine the comfort level of PCPs after an intervention based on current COPD evidence-based practice (EBP) guidelines. In addition, an inquiry regarding application of these guidelines into practice followed approximately six weeks post intervention.

Methods: An instructional session reviewing GOLD’s COPD guidelines and combined assessment tool took place in three Southern New Jersey primary care offices. A survey inquiring PCPs’ degree of comfort when making clinical decisions for the patient with COPD were administered immediately pre and post-intervention, and again six weeks post intervention after participants had the opportunity to utilize the evidence based tool in practice.

Results: Results showed a significant increase in PCPs’ comfort of decision-making immediately after the intervention compared to before the intervention (z = -3.061, p < 0.01), while there was a slight increase six weeks post intervention compared to before the intervention (z = -1.826, p = 0.068). Additionally, an inquiry during the six-week intervention follow-up revealed that participants were incorporating these guidelines into practice.

Conclusion: Findings support the utilization of EBP guidelines to improve providers’ comfort in clinical decision making and ultimately, patient outcomes. The data from this project showed an improvement in PCPs’ comfort level of clinical decision-making required for the management of patients with COPD. Most importantly, the clinical implications of this project displayed sustainability when participants revealed application of these guidelines into their personal practice.

Keywords: clinical decision making, chronic obstructive pulmonary disease (COPD), evidence based practice (EBP), Global Initiative for Chronic Obstructive Lung Disease (GOLD), primary care provider (PCP)