Impact of the CAPTURE COPD Screening Tool in US Primary Care: A Cluster Randomized Trial.

Abstract

Rationale: The impact of COPD screening on US primary care clinician behavior and patient outcomes is unclear. Objectives: Assess the impact of receiving CAPTURE (COPD Assessment in Primary Care to Identify Undiagnosed Respiratory Disease and Exacerbation Risk) screening scores on clinical and patient outcomes. Methods: 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 in patients with elevated screening scores or study spirometric abnormalities. Measurements and Main Results: Among 387 CAPTURE+ patients, no significant difference was noted between usual care and intervention practices in the primary composite outcome of: 1) spirometry referral/completion, 2) new COPD diagnosis, 3) newly prescribed inhaled long-acting respiratory medication, 4) referral to a respiratory specialist, or 5) pulmonary rehabilitation referral/completion, 45.9% versus 41.9% (+4.0%, 95% CI -6.9, +15.0, p=0.47). Only spirometry referral/completion was higher in the intervention group (+10.4%, 95% CI +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 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 pre-pandemic period that diminished during the pandemic. Conclusions: Within these US 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 pre-pandemic period CAPTURE+ patients were more likely to undergo spirometry referral completion while 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.