Impact of the CAPTURE Chronic Obstructive Pulmonary Disease Screening Tool in U.S. Primary Care: A Cluster-Randomized Trial
Year: 2024
Type: article
Study design: Clinical Trial
Abstract: Rationale The impact of screening for chronic obstructive pulmonary disease (COPD) on U.S. primary care clinician behavior and patient outcomes is unclear. Objectives We sought to assess the impact of receiving screening scores for clinical and patient outcomes using the COPD Assessment in Primary Care To Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE) tool. Methods This cluster-randomized trial included 49 usual-care (COPD education only) and 51 intervention (COPD and CAPTURE education plus screening scores) primary care practices. Twelve-month medical record and patient survey outcome data were collected from patients with elevated screening scores or study spirometric abnormalities. Measurements and Main Results Among 387 CAPTURE screen–positive (CAPTURE+) patients, no significant difference was noted between usual-care and intervention practices in the primary composite outcomes of 1) spirometry referral/completion, or 2) new COPD diagnosis, or 3) newly prescribed inhaled long-acting respiratory medication, or 4) referral to a respiratory specialist, or 5) pulmonary rehabilitation referral/completion; 45.9% versus 41.9%, respectively (absolute difference, 4.0%; 95% confidence interval, −6.9, 15.0; P = 0.47). Only spirometry referral/completion was higher in the intervention group (absolute difference, 10.4%; 95% confidence interval, 0.1, 20.7; P = 0.0465). No differences were noted for secondary outcomes, composite components, change in COPD Assessment Test scores, rates of respiratory illnesses, or hospitalizations. For the 1,028 CAPTURE screen−negative (CAPTURE−) patients, composite primary and all secondary outcomes were similar in the two arms. In secondary and post hoc analyses evaluating the potential impact of the pandemic, intervention group differences in clinician and patient outcomes were noted for CAPTURE+ and CAPTURE− patients in the prepandemic period that diminished during the pandemic. Conclusions Within these U.S. primary care practices, COPD and CAPTURE education plus receipt of CAPTURE screening scores did not change clinician COPD assessment or care or patient outcomes for CAPTURE+ patients. However, in the prepandemic period, CAPTURE+ patients were more likely to undergo spirometry referral completion, whereas for CAPTURE− patients, clinicians were significantly less likely to assess for COPD, suggesting that the intervention resulted in a more appropriate use of healthcare resources. Clinical trial registered with www.clinicaltrials.gov (NCT 03581227).
Authors: Fernando J. Martinez, Barbara P. Yawn, Daniela Angulo, Camden Lopez, Susan Murray, David Mannino, Stacey Anderson, Rowena Dolor, Nancy Elder, Min Joo, Irfan Khan, Lyndee M. Knox, Catherine Meldrum, Elizabeth Peters, Cathie Spino, Hazel Tapp, Byron Thomashow, Linda Zittleman, Randall Brown, Barry Make, MeiLan K. Han
Institutions: University of Massachusetts Chan Medical School, University of Michigan, Michigan Medicine, Weill Cornell Medicine, University of Minnesota, University of Minnesota Medical Center, University of Kentucky, Duke University, Duke Medical Center, Oregon Health & Science University, University of Illinois Chicago, Cornell University, NewYork–Presbyterian Hospital, Columbia University, University of Colorado Anschutz, University of Colorado Denver, Teva Pharmaceuticals (United States), National Jewish Health
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4405712448