Abstract

Project set out to support the correct diagnosis of chronic obstructive pulmonary disease in general practice by evaluating the delivery of quality assured spirometry
Patients' medical records were reviewed and categorized into groups:
Cohort A No spiro/no diagnosis but prescribed COPD medication
Cohort B Misdiagnosis of COPD
Cohort C Uncontrolled COPD
All patients received new quality assured spirometry with assessment by a consultant chest physician to support diagnosis.
On diagnostic confirmation (see below results) an embedded risk strategy to improve diagnosis, optimize management both pharmacologically and non-pharmacologically was implemented with a cardio-pulmonary risk factor template.
In England general practice quality and outcomes framework (QoF) has to be completed annually for GPs to be paid. Project highlighted patients did not receive standardised care. Therefore, it is hoped by upskilling HCPs this project will leave a legacy by improving, diagnosing and managing COPD and other comorbidities more robustly.
Results:
739 COPD patients were reviewed during this Quality Improvement Project.
72 patients confirmed as differential or non-COPD: broken into categories.
24 Non-COPD, No co-morbidity conditions all normal spirometry/asymptomatic but prescribed COPD medications (from SABA to triple therapy)
11 primary ‘cardiac’ disease, confirmed - patients did not have COPD
10 asthma patients confirmed - patients did not COPD but being treated for it
8 Bronchiectasis patients confirmed - patients did not have not COPD
50% COPD patients had an improved CAT score
25% of patients had management plans incorrectly completed
19 COPD patients with additional comorbidities i.e. emphysema, Bronchiectasis (confirmation by CT scan)
Of the 739-patients reviewed 667 patients were confirmed COPD with no additional comorbidities
Where possible patients were referred to non-pharmacological services, a selection of patients refused pulmonary rehab even though encouraged to attend