PCRS welcomes new QOF recommendation to improve COPD diagnosis

A new QOF indicator, which requires a diagnosis of COPD to have results of spirometry consistent with airways obstruction, has been approved by NICE.

PCRS has campaigned for this change in practice for many years.

This means that from April this year entry to the COPD register must be determined by the presence of a clinical diagnosis plus a record of post bronchodilator spirometry FEV1/FVC ratio below 0.7 recorded between 3 months before or 6 months after diagnosis.

The new indicator will both improve the accuracy and consistency of diagnosis of COPD and reduce the risk of overtreatment, says NICE.

PCRS Policy Lead Noel Baxter says: “This is a profound change to the COPD QOF. The primary care Royal College of Physicians’ National Asthma and COPD audits (NACAP) in Wales between 2014 and 2017 showed a worrying disparity between the QOF achievement for COPD confirmed by spirometry and the reality of whether the values obtained through spirometry are consistent with a diagnosis of airways obstruction. The good news for practices and primary care networks’ workload is that the requirement will start this year but only for new diagnosis.”

The recommended new respiratory QOF indicators are:
In the COPD domain:

• Entry to the COPD register will be determined by the presence of a clinical diagnosis plus a record of post bronchodilator spirometry FEV1/FVC ratio below 0.7 recorded between 3 months before or 6 months after diagnosis in diagnoses made on or after 1 April 2020
• The annual review will include a requirement to record the number of exacerbations in order to help guide future management and potentially avoidable emergency admissions.

In the asthma domain:

• Practices will be required to establish and maintain a register of patients aged 6 years and over with a diagnosis of asthma
• Practices will be expected to use a minimum of two diagnostic tests to confirm an asthma diagnosis. These tests should be performed up to 3 months before any date of diagnosis and up to 6 months after this date
• The content of the asthma review has been amended to incorporate aspects of care positively associated with better patient outcomes and self- management
• Practices will be required to record smoking exposure in children and young people under the age of 19 years.

You can read a PCRS commentary on the headlines and what they mean for primary and community based care.

Noel says: “We are expecting more detail by the end of March about what exactly will need to be recorded and performed in order to attract the necessary QOF points and will report back then.”