The use of clinical decision support system software to establish diagnostic accuracy and guide delivery of non-pharmacological treatment and self-management strategies in COPD (ID 445)

Chakrabarti B, O’Driscoll M, Litchfield D, Bazneh R, McKnight E, Bleem K, Cooper C, Osborne M, Pearson MG, Davies L, Angus RM

Liverpool University Hospitals NHS Foundation Trust

Funding: The COPD reviews were conducted by NSHI on behalf of GSK as part of a Joint Working arrangement between GSK and Berkshire West ICB. GSK was not involved in the analysis of data or the development or submission of this abstract

Abstract

Introduction: We report the impact of utilising the LungHealth© COPD Clinical Guided Consultation (CGC) when conducting COPD Reviews in the NHS Berkshire West CCG locality focusing on accuracy of diagnosis and non-pharmacological aspects of COPD management.
Methodology: The CGC is an intelligent clinical decision support system enabling the user to confirm the correct diagnosis of COPD with algorithms integrating history, physical signs and interpretation of spirometry subsequently staging COPD according to established guidelines and prompting pharmacological and non-pharmacological guideline-based management.
Results: 658 patients on the COPD GP register underwent annual COPD review using the CGC. Following CGC review, 17% were found not to have a diagnosis of COPD (McNemar’s test; p<0.001) leaving 549 patients with a confirmed COPD diagnosis (mean age 73 years (SD 10); 53% Male; MMRC score 2 (SD 1); 23% GOLD Group A, 53% Group B, 24% Group E). CGC review documented the presence of cardiac comorbidity in 29%, Diabetes Mellitus in 16% and in 5% flagged up new findings based on symptoms suggesting possible cardiac disease deemed to require further investigation. 28% were current cigarette smokers; all but two were counselled regarding Smoking Cessation following CGC prompting with CGC also offering referral to local Smoking Cessation services. CGC review resulted in an additional 41 patients (7%) receiving a written management plan regarding acute exacerbation management (McNemar’s test; p<0.001). The CGC determined 189 patients met ‘GOLD criteria” regarding suitability for pulmonary rehabilitation prompting referral where appropriate. 34% of this cohort had previously undertaken a pulmonary rehabilitation course and following structured CGC questioning, 93% felt that the pulmonary rehabilitation course had benefited them.
Conclusion: The use of clinical decision support system software when conducting COPD reviews in primary care enables patients to be diagnosed correctly, assesses relevant comorbidity and impacts on guideline-driven implementation including key non-pharmacological management strategies.

Conflicts of interest: Drs Chakrabarti, Angus, Davies, Professor Pearson and Mr McKnight are all directors of LungHealth Ltd.

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