P38\u2005Is a database search and clinical triage using the GP record feasible as a targeted case-finding approach for identification of undiagnosed COPD in primary care?

Abstract

IntroductionIdentifying undiagnosed COPD is high priority 1 Systematic, targeted case-finding in ever-smokers is cost-effective, outperforming routine primary care;however, even within the research setting of TargetCOPD, only 38% responded to screening questionnaires determining spirometry need 1 We explored the feasibility of an alternative - database search and triage of patient record by GP, to create an at-risk group for spirometry, as part of an integrated respiratory service development MethodsAn EMIS GP database search was iteratively developed to identify patients at risk of COPD, which included ever-smokers 35–90 years, who had also received relevant medication or had multiple respiratory consultations In protected time, three non-specialist GPs reviewed the record to identify likely airways disease and triaged to screening spirometry, diagnostic spirometry, no testing indicated or coding required (as diagnostic criteria already present) The patient and their GP were informed of COPD and asthma diagnoses ResultsOf 1231 patients in 20 practices who were highlighted by the search and received triage of their record, 8% (98) required coding, 41% (500), were triaged to screening spirometry and 15% (180) direct to diagnostic spirometry 37% (453) were considered irrelevant Triage time was 12 patients/hour In total, 81 COPD and 53 asthma cases were identified 65% (93/143) of patients attended on first invitation for spirometry and 55% of those who had diagnostic spirometry had airways disease;COPD (22) and asthma (14) After screening spirometry, 20%(7) went on to be diagnosed with COPD At project termination due to COVID-19, 537 patients had yet to be invited for spirometry and no second invitations had been sent Availability of diagnostic spirometry and its interpretation in primary care was variable, especially when complex;specialist support was required ConclusionsOur search strategy was specific, creating a manageable sample for clinical triage and follow-up spirometry in routine settings The process resulted in a high rate of diagnoses after spirometry and allowed rapid recognition of uncoded patients, equating to ≈69 additional COPD cases over routine care1 ReferenceJordan RE, et al Targeted case-finding for chronic obstructive pulmonary disease versus routine practice in primary care (TargetCOPD): a cluster-randomised controlled trial LancetRespir Med 2016;4(9):720–730