Specialist respiratory outreach: a case-finding initiative for identifying undiagnosed COPD in primary care.

Affiliation

Ray E(1)(2), Culliford D(1), Kruk H(1)(2), Gillett K(1)(2), North M(1)(2), Astles CM(1)(2), Hicks A(2), Johnson M(1), Lin SX(1), Orlando R(1), Thomas M(3), Jordan RE(4), Price D(5)(6), Konstantin M(2), Wilkinson TMA(7)(8)(9).
Author information:
(1)NIHR ARC Wessex, Faculty of Health Sciences, University of Southampton, Southampton, UK.
(2)University Hospital Southampton NHS Foundation Trust, Southampton, UK.
(3)Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK.
(4)Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
(5)Observational and Pragmatic Research Institute, Singapore, Singapore.
(6)Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
(7)Faculty of Medicine, University of Southampton, Southampton, UK. [Email]
(8)NIHR Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK. [Email]
(9)Wessex Investigational Sciences Hub, University of Southampton Faculty of Medicine, Southampton General Hospital, Southampton, UK. [Email]

Abstract

COPD remains largely undiagnosed or is diagnosed late in the course of disease. We report findings of a specialist outreach programme to identify undiagnosed COPD in primary care. An electronic case-finding algorithm identified 1602 at-risk patients from 12 practices who were invited to attend the clinic. Three hundred and eighty-three (23.9%) responded and 288 were enrolled into the study. Forty-eight (16.6%) had undiagnosed mild and 28 (9.7%) had moderate airway obstruction, meeting spirometric diagnostic criteria for COPD. However, at 12 months only 8 suspected COPD patients (10.6%) had received a diagnostic label in their primary care record. This constituted 0.38% of the total patient population, as compared with 0.31% of control practices, p = 0.306. However, if all patients with airway obstruction received a coding of COPD, then the diagnosis rate in the intervention group would have risen by 0.84%. Despite the low take-up and diagnostic yield, this programme suggests that integrated case-finding strategies could improve COPD recognition.