부산대학교 도서관

OBJECTIVES/GOALS: Studies to improve uptake of Chronic Obstructive Pulmonary Disease Clinical Practice Guidelines (COPD CPG) have yielded inconsistent results. We hypothesized that using implementation science would facilitate rigorous site ‘diagnosis’, and promote effective contextual tailoring of COPD CPG, while piloting the use of telehealth for this. METHODS/STUDY POPULATION: The study was conducted in two Veterans Affairs primary care clinics located in a small sized city. A detailed formative evaluation was conducted using key informant interviews (with VA staff and veterans with COPD who received care at this location) and quantitative data. Multidisciplinary stakeholder group was engaged and strategies to address the determinants identified through the previous step were identified. Telehealth was strongly encouraged as the primary modality for implementing the COPD CPG and we are collecting pilot data on this. Tele-Facilitation, used as the meta-strategy was employed in conjunction with other strategies such as develop/distribute educational materials, tailor strategies, change record systems and revise professional roles. RESULTS/ANTICIPATED RESULTS: Primary Care at the VA is provided by Patient Aligned Care Teams (PACT-teams), where each team consists of multiple health professionals to provide collaborative care to the patient. Discussions with the multidisciplinary stakeholder team suggested that any implementation effort primarily focused on physician and nursing efforts was unlikely to succeed due to competing demands. A pharmacy-centric model that allowed for the PACT-team clinical pharmacist to address most of the COPD CPG (inhaler technique education/assessment, inhaler choice optimization, COPD-specific patient education, spirometry use, smoking and immunization) was developed and implemented with incorporation of telehealth (video visits and telephone). We will present pilot implementation outcomes using RE-AIM framework elements. DISCUSSION/SIGNIFICANCE: This use of implementation science to implement COPD CPG and novel use of telehealth has enormous potential for impact. Increasing reach/adoption by targeting primary care practices can help permeate quality care to the underserved population. This data will allow us to explore generalizability through wider scale implementation studies.