Chronic Obstructive Pulmonary Disease (COPD)

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STATEMENT OF NEED: COPD is a significant cause of morbidity and mortality worldwide [1]. According to various burden of disease analyses [2], COPD is the fourth-leading cause of death in the U.S. and worldwide and is projected to become the third-leading cause of death by 2020. In the United States, an estimated 16 million adults have been diagnosed with COPD [2]. Mortality from COPD has increased 22 percent in the past decade, due in part to an aging population.

COPD is associated with high utilization of health care resources, including frequent clinician office visits, frequent hospitalizations due to acute exacerbations, and need for chronic therapy. Primary care physicians are well positioned to make an earlier diagnosis of COPD and potentially improve outcomes in this disease with earlier intervention. However, a 2009 needs assessment of primary care physicians conducted by PennCME/BestPractice revealed the following gaps in disease management:

  • Physicians often fail to identify patients with early signs of COPD.
  • Physicians and their staff lack adequate training and confidence in the use of and interpretation of the results of spirometry in diagnosis and staging.
  • Counseling about lifestyle changes for patients with COPD or at risk of COPD is inadequate, especially counseling and treatment to promote smoking cessation.
  • Communications systems that can improve ongoing care are inadequately used.
  • Physicians underprescribe safe, effective therapies and overuse ineffective therapies, contributing to exacerbation.
  • Physicians lack awareness about evidence-based disease management guidelines.

TARGET AUDIENCE: Primary care physicians, physician assistants, nurse practitioners, and other health care providers and clinical practice teams involved in the care of patients with COPD.

EDUCATIONAL GOALS & OBJECTIVES: After participating in this educational initiative, learners are expected to:

  • Improve timely diagnosis of COPD
  • Change practice patterns to reflect current guidelines and best practices
  • Minimize risk and improve management of comorbidities in patients with COPD
  • Demonstrate improved knowledge and application of guidelines/best practices for treatment of patients with COPD
  • Apply new knowledge to improve the organization of delivery of medical care in their practice setting; better integrate with community resources provided to patients; and provide culturally competent care to improve patient’s risk recognition and motivation to participate in health self-management

FORMATS & METHOD OF LEARNER PARTICIPATION IN THE PennCME/BestPractice COPD CURRICULUM LEARNING PROCESS:

  • Clinical reviews in COPD present critical areas of knowledge in the disease organized in a coherent pathway, along with practical approaches to achieving best practices. This section provides a foundation and reference base for other featured interventions.
  • Hot Topics are short, newsworthy articles in a focused area of the diagnosis or management of COPD. These articles are designed to engage the participant in the topic area and lead them to content that provides the opportunity for more in-depth learning.
  • Interactive Minicases offer a valuable learning experience based on real-life scenarios of interactions between primary care physicians, the health practice team, and patients with COPD. This method of engagement allows participants to build their knowledge and competence as they engage and progress through case simulation of  both the clinical management of patients with COPD and some system-specific issues  in their practices. 
  • Point-of-Care Search CME (PoC) includes structured, self-directed online learning on topics relevant to their clinical practice. Learning for this activity occurs through a reflective process in which physicians document the clinical question, cite the sources consulted, and identify the application of the learning to their practice.   
  • Simulations place physicians in the active role of problem solvers, letting them learn critical skills in a practical setting. The Patient Simulator provides individually tailored learning, allowing physicians to Increase Competence by applying new knowledge to diagnostic and therapeutic challenges in a non-threatening clinical environment.
  • Performance-Improvement CME consists of four phases. During the assessment phase, learners’ practice data is collected and assessed based on pre-determined evidence-based quality indicators. In the improvement phase, the learner is allowed meaningful time to make changes and improve practice based on a self-directed and structured improvement plan. A large number of targeted learning opportunities, interventions and strategies are provided during this phase. The evaluation phase allows for assessment of the impact of improvements made in the practice, using the same data collection and submission tools from the original assessment. Finally, reflection on the results of the practice-based performance improvement will establish an opportunity for the setting of future improvement goals.

FACULTY, AUTHORS, & CONTRIBUTORS:

Zalman S. Agus, MD, Editor-in-Chief
Associate Dean for CME
Emeritus Professor of Medicine
Perelman School of Medicine at the University of Pennsylvania
Philadelphia, Pennsylvania

David M. Mannino, MD, Faculty
Professor and Director, Pulmonary Epidemiology Research Laboratory
Department of Preventive Medicine and Environmental Health
University of Kentucky College of Public Health
Lexington, Kentucky

Jill A. Ohar, MD, FCCP, Faculty
Professor of Internal Medicine and Director of Clinical Operations
Section on Pulmonary, Critical Care, Allergy and Immunologic Disease
Wake Forest University School of Medicine
Winston-Salem, North Carolina

Lewis Miller, MS, CCMEP
Principal, WentzMiller & Associates
Darien, Connecticut

Mila Kostic, CME Director and Chief Learning Officer
Director of CME
Perelman School of Medicine at the University of Pennsylvania
Philadelphia, Pennsylvania

Katherine Wandersee, Medical Writer
Medical Consultant and Writer
Montclair, New Jersey

Wendy Turell, DrPH, Editorial Director

Joseph E. Scherger, MD, MPH, Editorial Board
Professor of Clinical Family and Preventive Medicine
Director, San Diego Center for Patient Safety
Medical Director, Quality Improvement Education
Director, Quality Improvement in Correctional Medicine
University of California, San Diego School of Medicine (USCD)
San Diego, California

Matthew H. Rusk, MD, Editorial Board
Associate Professor of Clinical Medicine
Program Director, Primary Care Program
Staff Internist, Division of General Medicine
Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania

Dennis F. Saver, MD,  Editorial Board
President and Staff Physician, Primary Care of the Treasure Coast
Clinical Assistant Professor of Family Medicine
Florida State University
Vero Beach, Florida

Peter J. Ziemkowski, MD,  Editorial Board
Assistant Professor, Department of Family Medicine
College of Human Medicine
Michigan State University
Clerkship Director and Physician/Faculty
Michigan State University–Kalamazoo Center for Medical Studies
Kalamazoo, Michigan

Patricia M. Bomalaski, MSN, CRNP, Editorial Board
Department of Medicine
Penn Center for Primary Care
Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania

Michael A. Rackover, PA-C, MS, Editorial Board
Associate Program Director & Associate Professor Physician Assistant Program Philadelphia University
Philadelphia, Pennsylvania

Jesse A. Coale, PA-C, Editorial Board
Assistant Professor Philadelphia University
Philadelphia, Pennsylvania

DISCLOSURES OF PERSONAL FINANCIAL RELATIONSHIPS: It is policy at the Perelman School of Medicine at the University of Pennsylvania for individuals who are in a position to control the content of an educational activity to disclose to the learners all relevant financial relationships with any commercial interest that provides products or services that may be relevant to the content of this continuing medical education activity. For this purpose, we consider relationships of the person involved in the CME activity to include financial relationships of a spouse or partner.

The intent of this policy is not to prevent expert faculty with relevant relationship(s) with commercial interest(s) from involvement in CME, but rather to ensure that Penn CME-certified activities promote quality and safety, are effective in improving medical practice, are based on valid content, and are independent of control from commercial interests and free of commercial bias. Peer review of all content was conducted for all faculty presentations whose disclosure information provided to the Penn Office of CME was found to contain relationships that created a conflict of interest relative to the topic of their presentation. In addition, all faculty were instructed to provide balanced, scientifically rigorous, and evidence-based presentations.

The staff in the Office of CME at the Perelman School of Medicine at the University of Pennsylvania, Mila Kostic, and Zalman Agus, MD, have reported no relevant financial relationships with any commercial interests related to the content of these educational activities.

The following staff member and medical writer have reported no relevant financial relationships with any commercial interests related to the content of these educational activities:  

  • Wendy Turell, DrPH, Editorial Director
  • Katherine Wandersee, Medical Writer

The following staff members have reported the listed relevant financial relationships with commercial interests related to the content of thee educational activities:

  • Lewis A. Miller, MD, is a consultant for Takeda Pharmaceuticals North America, Inc.

The following editorial board members have disclosed that they have no relevant financial relationships with any commercial interests related to the content of these educational activities:  

  • Patricia M. Bomalaski, MSN, CRNP
  • Matthew Rusk, MD
  • Joseph E. Scherger, MD, MPH
  • Peter Ziemkowski, MD
  • Jesse A. Coale, PA-C

The following faculty and editorial board members have reported the listed relevant financial relationships with commercial interests related to the content of these educational activities. 

Faculty Name  Name of Commercial Interest 

Relationship

David M. Mannino, MD GlaxoSmithKline    Research and Consultant
  Novartis Consultant
  Forest Consultant
  AstraZeneca Consultant and Speaker
  Pfizer   Research
  Boehringer Ingelheim Research
Jill Ohar, MD Advanced Life Support Consultant, Speaker, and Advisory Board
  ATS Pharmaceuticals Speaker
  AstraZeneca Consultant, Speaker, and Advisory Board
  France Foundation Speaker’s Bureau
  GlaxoSmithKline Speaker’s Bureau
  Neo-Health Care Speaker’s Bureau
  Pfizer Consultant
  Prime Inc. Consultant
  Sepracor Advisory Board Member
Dennis Saver, MD Boehringer Ingelheim and Genzyme Consultant
  First Consult  Board Member
Michael A. Rackover, PA-C, M.S GlaxoSmithKline Spouse is an employee

Instructions for Obtaining CME Credit

To obtain Credit Certificate for CME-certified activities follow these steps:

  • Review the topic- and activity-specific overview
  • Complete the brief case-based pre-activity assessment
  • Review the entire educational activity
  • Answer all case-based questions in the post-activity assessment
  • Complete the evaluation
  • Proceed to view or print your certificate stored in your Personal Learning Center

Accreditation
The Perelman School of Medicine at the University of Pennsylvania is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation of Credit
These activities have been approved for AMA PRA Category 1 Credit(s)™.

Disclosure of Commercial Support
Supported, in part, by educational grants from Abbott Laboratories,  Daiichi Sankyo, Inc., Genentech, Inc., GlaxoSmithKline, Lilly USA LLC, and Takeda Pharmaceuticals North America, Inc.

INVESTIGATIONAL AND/OR OFF-LABEL USE OF COMMERCIAL PRODUCTS AND DEVICES: The University of Pennsylvania School of Medicine requires all faculty to disclose any planned discussion of an investigational and/or off-label use of a pharmaceutical product or device within their presentation. Participants should note that the use of products outside FDA-approved labeling should be considered experimental and are advised to consult current prescribing information for approved indications.
The faculty reported that there will be no specific mentions of off-label and/or investigational use of products within their presentations.

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