Abstract

Background
COPD is a high-burden long-term condition in primary care, associated with exacerbations, emergency admissions, avoidable morbidity and substantial healthcare costs.1,3 Its management requires proactive identification, structured review, inhaler optimisation, symptom assessment, vaccination, smoking cessation support and pulmonary rehabilitation referral where appropriate.2,3 In pressured primary care settings, risk stratification may help practices identify patients most in need and deliver guideline-aligned care.1,2,3

Aim
To assess whether pharmacist-led, protocol-driven risk stratification could identify COPD patients at greatest risk, uncover unmet clinical need, and deliver timely intervention in primary care.

Methods
51,000 patients with COPD were reviewed through services funded by GlaxoSmithKline UK Limited as a donation freely given to support healthcare. Screen Clinical Limited pharmacists completed 21,880 COPD reviews across 269 practices under the OPTIMISE COPD protocol.4 Patients were risk stratified using exacerbation history, prescribing data, hospitalisation markers, eosinophil count, symptom burden and predefined criteria aligned to guidelines.2,3 GP-authorised 20-minute reviews were delivered, covering inhaler technique, adherence, symptoms, exacerbations, vaccination status, smoking support, lifestyle advice, pulmonary rehabilitation referral and pharmacological optimisation.2,3

Results
Pre-clinic analysis demonstrated substantial unmet need despite existing treatment. Exacerbation burden was identified in 77.1% of patients. Most reviews were completed face-to-face (68%). Inhaler technique review increased from 51.1% to 90.4%, CAT recording from 92.9% to 97.5%, and MRC recording from 64.7% to 99.3% and 99% of patients received a self-management plan. Preventative interventions including vaccination recommendations, smoking cessation support and pulmonary rehabilitation referral were routinely delivered. Following review, single-inhaler triple therapy increased from 45.6% to 57.7%. Monotherapy reduced from 6.0% to 1.7%.4

Conclusion
This work identified unmet need and helped practices prioritise patients at greatest risk.4 Without structured review, this population may have remained exposed to preventable exacerbation risk, deterioration and avoidable demand on primary, urgent and secondary care. 1,2,3 The model delivered scalable pharmacist-led care optimisation, improving treatment, respiratory assessment and preventative care.2,3,4

References

1.NHS RightCare. RightCare Pathway: Chronic obstructive pulmonary disease. NHS England; 2017.

2.NICE. Chronic obstructive pulmonary disease in over 16s: diagnosis and management. NG115.

3.GOLD. Global Strategy for the Diagnosis, Management, and Prevention of COPD: 2025 Report.

4.Screen Clinical OPTIMISE COPD service evaluation data, 2025.