Using State-based Epidemiology Data to Target Chronic Obstructive Pulmonary Disease at a Community Level

 

The Behavioral Risk Factor Surveillance System has recently been used to help define the prevalence and impact of chronic obstructive pulmonary disease in the USA, initially in North Carolina in 2007 and 2009.   Using data from this surveillance study, the North Carolina COPD Taskforce, supported by the NHLBI’s Learn More Breathe Better COPD campaign, initiated 2 community-based demonstration projects to target high-risk COPD populations. The first project involved a county-wide effort in Davidson County, NC, a community with one of the highest COPD prevalence rates in the state.  This effort involved a public awareness campaign as well as working with all healthcare  providers and facilities in the community.  Public awareness efforts included local newspaper, radio, television, billboard, and COPD screenings at community events.  Healthcare providers were targeted through multiple education programs, provision of COPD-related resources, and development of a Tobacco Quit Team at a local hospital.  Use of the Tobacco Quitline was promoted to local community pharmacies. Particular emphasis was placed on the local indigent clinic as a target population.  Notably, there was a significant increase in number of ED and hospitalizations for COPD after this project, likely related to an increase in new diagnosis of the disease. The use of the state tobacco Quitline tripled in the county as a consequence of the interventions.

The second demonstration project using BRFSS epidemiological data involved targeted efforts at indigent clinics (6 Free Clinics) in NC, SC, and Va.  A process was initiated at each clinic to systematically screen for tobacco use,  identify persons at high risk for COPD, and perform diagnostic spirometry.  In addition to targeted efforts at the indigent clinics, public awareness campaigns were undertaken using local media in each community.  All pharmacies in the local communities were engaged to refer smokers to the State tobacco quitlines. Through this process and provision of a spirometer, there were more than 500 patients identified as high-risk for COPD; subsequently underwent spirometry, and referred for smoking cessation counseling through the respective State tobacco quitlines. There were more than 100 new diagnosis of COPD during the 3 month demonstration project.  Quitline referrals in local areas were variably affected by the demonstration project. In summary, use of state-based epidemiological COPD data to explore community-based interventions appears to be a useful strategy to target the disease and warrants further exploration.