Background:

Chronic obstructive pulmonary disease (COPD) is a common, preventable and treatable lung disease. COPD makes it harder for a person to get air in and out of the lungs. Symptoms include shortness of breath, cough, excess phlegm and wheezing. COPD can cause a huge impact on a person's life and lead to poor health. 

Question:

What evidence exists for educational interventions delivered to health professionals managing COPD in primary care?

Search strategy:

To find relevant studies, we searched six online databases, trial registries and the reference list of included studies, retrieving studies published up until May 2021. 

Selection criteria:

We included randomised controlled trials (RCTs) or studies of similar design comparing a group of health professionals or patients (or both) receiving an intervention with a group receiving usual care (no intervention) or receiving a different intervention. We included trials that studied educational interventions aimed at any health professionals involved in the management of COPD in primary care. 

Main results:

We identified 38 studies, 36 of which tested interventions versus usual care, and seven of which compared two or more different types of interventions. A range of simple to complex interventions were used across the studies, including education provided to health professionals via sessions, workshops or online modules (31 studies), provision of practice support tools or tool kits (10 studies), provision of COPD clinical practice guidelines (nine studies) and training on lung function tests (five studies). 

The studies we identified were very different in terms of who received the interventions, what interventions people received, where the interventions were delivered, and how and when the outcomes were measured. Due to these differences and problems with how the trials were conducted, we mostly considered the overall quality of the evidence to be low or very low.

Based on the current evidence, we were unable to determine the effects of educational interventions for health professionals on the proportion of COPD diagnoses confirmed with lung function tests, the proportion of patients with COPD who participated in pulmonary rehabilitation (specialised education and exercises to improve breathing) and the proportion of patients with COPD who were prescribed medications for their lungs/breathing that were consistent with recommended guidelines. However, the available evidence does suggest that educational interventions for health professionals probably improve influenza (flu) vaccination rates among patients with COPD and patient satisfaction with care.   

Author's conclusions:

It was unclear whether educational interventions improved COPD management in primary care, including COPD diagnosis confirmed with lung function tests, participation in pulmonary rehabilitation and prescribing of guideline-recommended respiratory medication. However, educational interventions for health professionals may improve influenza vaccination rates and patient satisfaction with care. Interventions and outcomes varied greatly among studies, and there were problems regarding how the trials were conducted, which may have affected their results. Further high-quality studies are necessary to determine the effectiveness of educational interventions for health professionals managing COPD in primary care. 

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