🏅 Best Practice / Service Development Poster Winner
Standardising COPD management in Primary Care with a remote clinical pathway using Computer Guided Consultation software as an effective strategy to aid elective recovery: A Norfolk and Waveney CCG case study (ID 383)
National Services for Health Improvement
Funding: Some of the data used in this publication was funded by GlaxoSmithkline UK Ltd., and collaboratively developed and delivered with NSHI Ltd. as a service to medicine
Abstract
Background: We have previously reported on using a computer guided consultation (CGC) to undertake “face to face” COPD reviews within primary care. This study aims to evaluate the role of the CGC within a clinical pathway where primary care COPD reviews are conducted in a remote capacity.Methodology/Clinical pathway: The CGC (LungHealth Ltd) is an intelligent decision support system ensuring holistic guideline-based diagnosis and review for COPD patients. Patients on COPD registers in Norfolk and Waveney CCG underwent remote review with video consultation using the CGC linked directly to the GP clinical system following an initial remote review of clinical records and any prior spirometry.
Results: 6,892 patients across 26 practices initially underwent remote review of their clinical record and spirometry traces. Of these, 3,850 (56%) met the diagnosis of COPD based on ARTP spirometry standards. 1,818 (26%) patients did not meet ARTP standards and 1,224 (18%) patients had no spirometry performed at all yet had a diagnostic label of COPD that not highlighted previously (McNemar’s test; p<0.001).
1,877 patients all labelled as COPD GOLD group D on the register, were subsequently invited for CGC review of which 1,661 underwent CGC review (73% remotely). Of these, 243 (15%) either did not have a diagnosis of COPD (CGC supported interpretation) or were alerted by the software as warranting urgent medical attention following CGC review. None had been identified prior to CGC review (McNemar’s test; p<0.001). In these 1661 patients, the CGC review resulted in 1447 guideline based medicinal interventions specifically for COPD.
Conclusion: This remote pathway for COPD reviews embedding the use of computer guided consultation software resulted in assisting in the improved accuracy of diagnoses including COPD and other causes of respiratory symptoms and an increase in the implementation of key guideline-based interventions thus facilitating elective recovery following the pandemic.
Conflicts of interest: None
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