Please select the eligibility criteria that correspond to the clinical trial below.
Title: Tailored Implementation for Chronic Diseases.
Brief Summary: Background: Chronic Obstructive Pulmonary Disease (COPD) remains a major health problem, which is strongly related to smoking. Despite publication of guidelines on the prevention and treatment of COPD, not all COPD patients receive the best available healthcare. Investigators developed a tailored implementation strategy for improving primary care physicians' adherence to COPD management guidelines. The primary aim of the presented trial is to evaluate the effects of this strategy on physician's performance. The secondary aim is to examine the validity of the tailoring of implementation interventions.

Primary Trial Hypothesis: To study if the rate of adherence to the COPD guideline over a 1 year will increase among participants assigned to the intervention group in comparison to those assigned to the control group?

Methods/Design: A two-arm pragmatic cluster randomized trial is planned. A total of 540 patients with diagnosed COPD will be included from 18 general practices in Poland. A tailored implementation program will be offered to general practitioners. Participating physicians in the intervention practices (n=18) will receive training to provide brief anti-smoking counselling. An additional form containing COPD severity scale will be inserted into patient's medical records. The checklist with key information about the disease and its management while consulting a patient with COPD will be provided to practitioners. Investigators will provide practices with training inhaler devices for general practitioners (GPs) to teach patients in correct use of each device and to note this education/training in patient's medical records. The control practices will provide usual care.

Discussion: The results of this trial will be directly applicable to primary care in Poland and add to the growing body of evidence on interventions to improve chronic illness care.


Options:
A: Inclusion Criteria:

* patients with diagnosed COPD via the medical records with code J44

Exclusion Criteria:

* terminal illness
* cognitive impairments
B: Inclusion Criteria:

* patients aged 65 years and older
* must have a minimum of three chronic or vitality threatening diseases and/or use five or more medical drugs chronically in the last year
* must have dyspnea and/or reduced exercise tolerance (scored by two short questionnaires)

Exclusion Criteria:

* patients with both confirmed COPD and heart failure (Spirometry performed \< 1 year ago and heart failure confirmed by echocardiography)
* patients unable or unwilling to sign informed consent
C: Inclusion Criteria:

* Age \>40 years
* Chart-document severe or very severe COPD (FEV1\<50% predicted) or COPD-related ED/hospitalization ≥ 1 visit within the past 12 months
* Prescribed any daily medication for COPD, English or Spanish speaking, Smoking history ≥ 10 pack-years

Exclusion Criteria:

* Diagnosis in the clinical record of dementia, because the study focuses on patients with capacity to independently perform self-management tasks.
D: Inclusion criteria:

* Males and females = 45yrs of age and
* Smoker or ex-smoker (with at least 10 PY) and
* Obstruction in spirometry FEV1/FVC\< 0.7

Exclusion criteria:

* No obstruction in spirometry (FEV1/FVC \> 0.7) or
* Patients with history of asthma or hay fever or
* Other concomitant pulmonary disease or
* Patients with malignancies of any other system and/or other severe disease with an estimated life expectancy of less than six months or
* Insufficient German language skills or
* Patients who contact the practice for emergencies only or as a substitute practice

Answer: A