Identifying cases of undiagnosed, clinically significant COPD in primary care: Qualitative insight from patients in the target population

Nancy K. Leidy, Katherine Kim, Elizabeth D. Bacci, Barbara P. Yawn, David M. Mannino, Byron M. Thomashow, R. Graham Barr, Stephen I. Rennard, Julia F. Houfek, Meilan K. Han, Catherine A. Meldrum, Barry J. Make, Russ P. Bowler, Anna W. Steenrod, Lindsey T. Murray, John W. Walsh, Fernando Martinez

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background:Many cases of chronic obstructive pulmonary disease (COPD) are diagnosed only after significant loss of lung function or during exacerbations.Aims:This study is part of a multi-method approach to develop a new screening instrument for identifying undiagnosed, clinically significant COPD in primary care.Methods:Subjects with varied histories of COPD diagnosis, risk factors and history of exacerbations were recruited through five US clinics (four pulmonary, one primary care). Phase I: Eight focus groups and six telephone interviews were conducted to elicit descriptions of risk factors for COPD, recent or historical acute respiratory events, and symptoms to inform the development of candidate items for the new questionnaire. Phase II: A new cohort of subjects participated in cognitive interviews to assess and modify candidate items. Two peak expiratory flow (PEF) devices (electronic, manual) were assessed for use in screening.Results:Of 77 subjects, 50 participated in Phase I and 27 in Phase II. Six themes informed item development: exposure (smoking, second-hand smoke); health history (family history of lung problems, recurrent chest infections); recent history of respiratory events (clinic visits, hospitalisations); symptoms (respiratory, non-respiratory); impact (activity limitations); and attribution (age, obesity). PEF devices were rated easy to use; electronic values were significantly higher than manual (P<0.0001). Revisions were made to the draft items on the basis of cognitive interviews.Conclusions:Forty-eight candidate items are ready for quantitative testing to select the best, smallest set of questions that, together with PEF, can efficiently identify patients in need of diagnostic evaluation for clinically significant COPD.

Original languageEnglish (US)
Article number15024
Journalnpj Primary Care Respiratory Medicine
Volume25
DOIs
StatePublished - Apr 16 2015

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Health Services Needs and Demand
Chronic Obstructive Pulmonary Disease
Primary Health Care
Interviews
Lung
Medical History Taking
Equipment and Supplies
Tobacco Smoke Pollution
Ambulatory Care
Focus Groups
Hospitalization
Thorax
Obesity
Smoking
Infection

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Public Health, Environmental and Occupational Health

Cite this

Identifying cases of undiagnosed, clinically significant COPD in primary care : Qualitative insight from patients in the target population. / Leidy, Nancy K.; Kim, Katherine; Bacci, Elizabeth D.; Yawn, Barbara P.; Mannino, David M.; Thomashow, Byron M.; Barr, R. Graham; Rennard, Stephen I.; Houfek, Julia F.; Han, Meilan K.; Meldrum, Catherine A.; Make, Barry J.; Bowler, Russ P.; Steenrod, Anna W.; Murray, Lindsey T.; Walsh, John W.; Martinez, Fernando.

In: npj Primary Care Respiratory Medicine, Vol. 25, 15024, 16.04.2015.

Research output: Contribution to journalArticle

Leidy, NK, Kim, K, Bacci, ED, Yawn, BP, Mannino, DM, Thomashow, BM, Barr, RG, Rennard, SI, Houfek, JF, Han, MK, Meldrum, CA, Make, BJ, Bowler, RP, Steenrod, AW, Murray, LT, Walsh, JW & Martinez, F 2015, 'Identifying cases of undiagnosed, clinically significant COPD in primary care: Qualitative insight from patients in the target population', npj Primary Care Respiratory Medicine, vol. 25, 15024. https://doi.org/10.1038/npjpcrm.2015.24
Leidy, Nancy K. ; Kim, Katherine ; Bacci, Elizabeth D. ; Yawn, Barbara P. ; Mannino, David M. ; Thomashow, Byron M. ; Barr, R. Graham ; Rennard, Stephen I. ; Houfek, Julia F. ; Han, Meilan K. ; Meldrum, Catherine A. ; Make, Barry J. ; Bowler, Russ P. ; Steenrod, Anna W. ; Murray, Lindsey T. ; Walsh, John W. ; Martinez, Fernando. / Identifying cases of undiagnosed, clinically significant COPD in primary care : Qualitative insight from patients in the target population. In: npj Primary Care Respiratory Medicine. 2015 ; Vol. 25.
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abstract = "Background:Many cases of chronic obstructive pulmonary disease (COPD) are diagnosed only after significant loss of lung function or during exacerbations.Aims:This study is part of a multi-method approach to develop a new screening instrument for identifying undiagnosed, clinically significant COPD in primary care.Methods:Subjects with varied histories of COPD diagnosis, risk factors and history of exacerbations were recruited through five US clinics (four pulmonary, one primary care). Phase I: Eight focus groups and six telephone interviews were conducted to elicit descriptions of risk factors for COPD, recent or historical acute respiratory events, and symptoms to inform the development of candidate items for the new questionnaire. Phase II: A new cohort of subjects participated in cognitive interviews to assess and modify candidate items. Two peak expiratory flow (PEF) devices (electronic, manual) were assessed for use in screening.Results:Of 77 subjects, 50 participated in Phase I and 27 in Phase II. Six themes informed item development: exposure (smoking, second-hand smoke); health history (family history of lung problems, recurrent chest infections); recent history of respiratory events (clinic visits, hospitalisations); symptoms (respiratory, non-respiratory); impact (activity limitations); and attribution (age, obesity). PEF devices were rated easy to use; electronic values were significantly higher than manual (P<0.0001). Revisions were made to the draft items on the basis of cognitive interviews.Conclusions:Forty-eight candidate items are ready for quantitative testing to select the best, smallest set of questions that, together with PEF, can efficiently identify patients in need of diagnostic evaluation for clinically significant COPD.",
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T2 - Qualitative insight from patients in the target population

AU - Leidy, Nancy K.

AU - Kim, Katherine

AU - Bacci, Elizabeth D.

AU - Yawn, Barbara P.

AU - Mannino, David M.

AU - Thomashow, Byron M.

AU - Barr, R. Graham

AU - Rennard, Stephen I.

AU - Houfek, Julia F.

AU - Han, Meilan K.

AU - Meldrum, Catherine A.

AU - Make, Barry J.

AU - Bowler, Russ P.

AU - Steenrod, Anna W.

AU - Murray, Lindsey T.

AU - Walsh, John W.

AU - Martinez, Fernando

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N2 - Background:Many cases of chronic obstructive pulmonary disease (COPD) are diagnosed only after significant loss of lung function or during exacerbations.Aims:This study is part of a multi-method approach to develop a new screening instrument for identifying undiagnosed, clinically significant COPD in primary care.Methods:Subjects with varied histories of COPD diagnosis, risk factors and history of exacerbations were recruited through five US clinics (four pulmonary, one primary care). Phase I: Eight focus groups and six telephone interviews were conducted to elicit descriptions of risk factors for COPD, recent or historical acute respiratory events, and symptoms to inform the development of candidate items for the new questionnaire. Phase II: A new cohort of subjects participated in cognitive interviews to assess and modify candidate items. Two peak expiratory flow (PEF) devices (electronic, manual) were assessed for use in screening.Results:Of 77 subjects, 50 participated in Phase I and 27 in Phase II. Six themes informed item development: exposure (smoking, second-hand smoke); health history (family history of lung problems, recurrent chest infections); recent history of respiratory events (clinic visits, hospitalisations); symptoms (respiratory, non-respiratory); impact (activity limitations); and attribution (age, obesity). PEF devices were rated easy to use; electronic values were significantly higher than manual (P<0.0001). Revisions were made to the draft items on the basis of cognitive interviews.Conclusions:Forty-eight candidate items are ready for quantitative testing to select the best, smallest set of questions that, together with PEF, can efficiently identify patients in need of diagnostic evaluation for clinically significant COPD.

AB - Background:Many cases of chronic obstructive pulmonary disease (COPD) are diagnosed only after significant loss of lung function or during exacerbations.Aims:This study is part of a multi-method approach to develop a new screening instrument for identifying undiagnosed, clinically significant COPD in primary care.Methods:Subjects with varied histories of COPD diagnosis, risk factors and history of exacerbations were recruited through five US clinics (four pulmonary, one primary care). Phase I: Eight focus groups and six telephone interviews were conducted to elicit descriptions of risk factors for COPD, recent or historical acute respiratory events, and symptoms to inform the development of candidate items for the new questionnaire. Phase II: A new cohort of subjects participated in cognitive interviews to assess and modify candidate items. Two peak expiratory flow (PEF) devices (electronic, manual) were assessed for use in screening.Results:Of 77 subjects, 50 participated in Phase I and 27 in Phase II. Six themes informed item development: exposure (smoking, second-hand smoke); health history (family history of lung problems, recurrent chest infections); recent history of respiratory events (clinic visits, hospitalisations); symptoms (respiratory, non-respiratory); impact (activity limitations); and attribution (age, obesity). PEF devices were rated easy to use; electronic values were significantly higher than manual (P<0.0001). Revisions were made to the draft items on the basis of cognitive interviews.Conclusions:Forty-eight candidate items are ready for quantitative testing to select the best, smallest set of questions that, together with PEF, can efficiently identify patients in need of diagnostic evaluation for clinically significant COPD.

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