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New RCP report highlights inconsistencies in diagnosis and management of COPD in Wales

Today, the Royal College of Physicians (RCP) has launched Primary care: Time to take a breath, the UK’s first ever primary care snapshot audit assessing the clinical effectiveness of Chronic Obstructive Pulmonary Disease (COPD) care in Wales.

COPD inflicts a huge toll on individual patients, their carers, and on the NHS. In total, 1.2 million people in the UK have been diagnosed with COPD, making it the second most common lung disease in the country. Along with lung cancer and pneumonia, COPD is also one of the three leading contributors to respiratory mortality in the UK; approximately 30,000 people die of the disease each year. In 2012 in Wales, the prevalence of diagnosed COPD was 2173 per 100,000 people. The death rate and emergency admissions from COPD in Wales in 2014 were approximately 52 and 274 per 100,000 people, respectively.

Using data provided by 280 practices across Wales, including 48,105 COPD patients, the report highlights areas for quality improvement and sets out a series of key priorities for both general practices and Health Boards.

Primary care: Time to take a breath

In the first of a series of reports, the comprehensive findings demonstrate that there are clear inconsistencies in the electronic coding, diagnosis and management of COPD. Approximately one quarter of people who had an appropriate test to confirm their diagnosis had a result recorded that was inconsistent with COPD. These individuals should have undergone further tests to confirm the cause of their symptoms, rather than receive treatment for COPD. From the data available, it was not possible to determine whether any additional tests were completed, but in these instances it is vital that other causes of breathlessness are considered. In some cases the conditions causing these symptoms can be serious, including lung cancer or non-respiratory conditions such as heart failure, and should be treated rapidly and appropriately.

Despite a good general provision of life-enhancing and prolonging COPD treatments, results indicate well evidenced, highly cost-effective interventions are under-used. Evidence shows that the annual flu vaccine, tobacco dependence treatment and pulmonary rehabilitation provide best value in comparison to other COPD interventions, but many people with COPD are not accessing these treatment options.

The key recommendations from the report are:

  • More accurate diagnosis should be prioritised
  • People with a confirmed COPD diagnosis should be offered  the treatment that will provide them with the best outcome in the most cost-effective way
  • Individuals presenting with a higher risk of rapid progression to severe disease need to be identified as soon as possible and offered intensive treatment with optimal therapies
  • General practice needs support to improve consistent electronic coding of health records, specifically COPD diagnosis, treatment and referral, in order to ensure that future allocation of resource is focused where need and impact will be greatest.

In order to make measurable quality improvements in the primary care treatment of COPD, GPs must be able to allocate sufficient resource within their organisations.

In order to make measurable quality improvements in the primary care treatment of COPD, GPs must be able to allocate sufficient resource within their organisations. This will enable better provision of a systematic and personalised approach to diagnosis and treatment of people with symptoms of COPD, to improve patient understanding of the condition and, therefore, improve quality of life.  To that effect, the report provides a wide variety of resources to support GP practices in working with COPD patients, to facilitate timely and appropriate diagnoses and access to treatment.

Dr Noel Baxter, clinical lead for primary care work stream said:

COPD is a disease that affects the least well off in our society and is usually caused by smoking and removal of the cause is the only thing that can slow progression of the disease.

Treatment for tobacco dependency is highly cost effective, but the audit shows it is an underused form of therapy. For those that are working towards or already living smoke free, access to pulmonary rehabilitation, a personalised programme of education and professionally supported physical activity, is an essential part of treatment but is also chronically underused.

Dr Robin Ghosal, RCP specialty lead for respiratory medicine in Wales and consultant physician at Prince Philip Hospital in Llanelli said:

I welcome this report from the Royal College of Physicians. It highlights the importance of early diagnosis, which we know makes a huge difference to patients’ lives.

The report’s findings also reflect the prudent healthcare principles of NHS Wales. There are lots of cost-effective treatments out there for COPD, but we aren’t making enough use of them. Instead, we’re doing what we’ve always done, and this needs to change. We also need to get much better at involving patients in making decisions about their care.

This report shows that there’s plenty of opportunity to improve COPD outcomes, but this will require real investment in primary care diagnosis. The Welsh Government should focus on resourcing the respiratory health delivery plan and giving clinicians the tools to put patients at the centre of their care.

For more information about this report and the National COPD Audit, contact the programme team.

Follow @RCPLondon and @NatCOPDAudit on Twitter to stay up to date with the latest developments from the COPD audit team, and join the conversation using #COPDaudit