Patient-specific electronic messaging from a pulmonology specialist to a primary care clinician improved guideline concordant chronic obstructive pulmonary disease (COPD) and pulmonary rehabilitation care, according to findings intended to be presented at the American Thoracic Society (ATS) International Conference, but that may be provided in a virtual format later this year.

Weekly chart reviews of a primary care population were conducted by a pulmonologist from March 2018 to 2019. Patients with probably COPD, apparent gaps in care, no obvious contraindication to spirometry or pulmonary rehabilitation, and an upcoming primary care appointment were identified. Approximately 1 week before the patient’s primary care appointment, electronic messages were sent to the primary care provider by the pulmonologist. The outcome of the message was obtained by chart review at the primary care appointment; primary care physicians could reply to the message to ask questions of the pulmonologist or to provide feedback. 

The primary outcomes of the study were orders for spirometry and referrals for pulmonary rehabilitation; secondary outcomes included acceptability to primary care clinicians. A total of 414 patient charts underwent detailed review by a pulmonologist; 161 patients (39%) with probably COPD, an apparent gap in care, and no obvious contraindication to spirometry or pulmonary rehabilitation were identified. A total of 66 patients had no spirometry and 95 patients appeared eligible for pulmonary rehabilitation but were not referred. Of spirometry messages sent, 33% resulted in an order for spirometry; 32% of pulmonary rehabilitation messages sent resulted in a referral for pulmonary rehabilitation.

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Primary care clinician feedback was provided for 62 messages: 82% positive, 16% neutral or asked clarifying questions, and 2% negative. The remaining messages received no feedback.

“This form of communication appears acceptable to [primary care physicians] and has potential to improve population-based COPD care,” the authors concluded.


Atkins G, Klein RM. Preemptive, patient-specific, electronic messaging from a pulmonologist to primary care practitioners improves guideline concordant chronic obstructive pulmonary disease care. Am J Respir Crit Care Med. 2020;201:A2749.

This article originally appeared on Pulmonology Advisor