Accuracy of diagnosis and classification of COPD in primary and specialist nurse-led respiratory care in Rotherham, UK: a cross-sectional study

Strong, Mark; Green, Angela; Goyder, Elizabeth; Miles, Gail; Lee, Andrew; Basran, G.S.; Cooke, Jo

doi:10.4104/pcrj.2014.00005

Cited by 27 publications

(27 citation statements)

References 32 publications

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“…For example, in a study of 1,205 patients with a primary care diagnosis who were admitted for pulmonary rehabilitation between 2007 and 2010 in Rotherham, England, 20% of spirometry results reported on the referral form were inconsistent with a diagnosis of COPD; among patients diagnosed with COPD and referred by respiratory specialists, only 6.5% had an inconsistent spirometry result. 19 Among those patients with a primary care referral diagnosis of COPD that had an inconsistent spirometry result, the most common subsequent diagnosis was asthma. 19 Remote reporting of spirometry tests from primary care physicians to a pulmonary specialist in the United Kingdom has been shown to be feasible and resulted in more accurate interpretations.…”

Section: Discussionmentioning

confidence: 99%

Geographic Accessibility of Pulmonologists for Adults With COPD

Croft

Zhang

et al. 2016

Chest

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BACKGROUND Geographic clusters in prevalence and hospitalizations for COPD have been identified at national, state, and county levels. The study objective is to identify county-level geographic accessibility to pulmonologists for adults with COPD. METHODS Service locations of 12,392 practicing pulmonologists and 248,160 primary care physicians were identified from the 2013 National Provider Identifier Registry and weighted by census block-level populations within a series of circular distance buffer zones. Model-based county-level population counts of US adults ≥ 18 years of age with COPD were estimated from the 2013 Behavioral Risk Factor Surveillance System. The percentages of all estimated adults with potential access to at least one provider type and the county-level ratio of adults with COPD per pulmonologist were estimated for selected distances. RESULTS Most US adults (100% in urbanized areas, 99.5% in urban clusters, and 91.7% in rural areas) had geographic access to a primary care physician within a 10-mile buffer distance; almost all (≥ 99.9%) had access to a primary care physician within 50 miles. At least one pulmonologist within 10 miles was available for 97.5% of US adults living in urbanized areas, but only for 38.3% in urban clusters and 34.5% in rural areas. When distance increased to 50 miles, at least one pulmonologist was available for 100% in urbanized areas, 93.2% in urban clusters, and 95.2% in rural areas. County-level ratios of adults with COPD per pulmonologist varied greatly across the United States, with residents in many counties in the Midwest having no pulmonologist within 50 miles. CONCLUSIONS County-level geographic variations in pulmonologist access for adults with COPD suggest that those adults with limited access will have to depend on care from primary care physicians.

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Section: Discussionmentioning

confidence: 99%

Geographic Accessibility of Pulmonologists for Adults With COPD

Croft

Zhang

et al. 2016

Chest

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“…However, the possibility of misdiagnosis of COPD remains. 35 , 36 A 2004 start for this analysis also coincides with the NICE COPD guidelines being published which recommended PR for patients diagnosed with COPD with a MRC dyspnoea score of 3 or worse. 4 Large differences exist among pulmonary rehabilitation programmes worldwide, 37 making it is difficult to generalise wider than the UK processes of referral and healthcare delivery.…”

Section: Discussionmentioning

confidence: 77%

The recording and characteristics of pulmonary rehabilitation in patients with COPD using The Health Information Network (THIN) primary care database

Hakamy

McKeever

Gibson

et al. 2017

npj Prim Care Resp Med

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Pulmonary rehabilitation is recommended for patients with COPD to improve physical function, breathlessness and quality of life. Using The Health Information Network (THIN) primary care database in UK, we compared the demographic and clinical parameters of patients with COPD in relation to coding of pulmonary rehabilitation, and to investigate whether there is a survival benefit from pulmonary rehabilitation. We identified patients with COPD, diagnosed from 2004 and extracted information on demographics, pulmonary rehabilitation and clinical parameters using the relevant Read codes. Thirty six thousand one hundred and eighty nine patients diagnosed with COPD were included with a mean (SD) age of 67 (11) years, 53% were male and only 9.8% had a code related to either being assessed, referred, or completing pulmonary rehabilitation ever. Younger age at diagnosis, better socioeconomic status, worse dyspnoea score, current smoking, and higher comorbidities level are more likely to have a record of pulmonary rehabilitation. Of those with a recorded MRC of 3 or worse, only 2057 (21%) had a code of pulmonary rehabilitation. Survival analysis revealed that patients with coding for pulmonary rehabilitation were 22% (95% CI 0.69–0.88) less likely to die than those who had no coding. In UK THIN records, a substantial proportion of eligible patients with COPD have not had a coded pulmonary rehabilitation record. Survival was improved in those with PR record but coding for other COPD treatments were also better in this group. GP practices need to improve the coding for PR to highlight any unmet need locally.

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“…Improving diagnostic accuracy relied particularly on the provision of quality assured spirometry and where needed additional near-patient tests (eg, fraction of exhaled nitric oxide testing). Accurate diagnosis is fundamental to the appropriate provision of preventive therapy,21 enabling appropriate management tailored to each condition, for example, ICS in asthma and pulmonary rehabilitation in COPD, and may help to avoid treatment that is of no benefit or harmful 22. The shift shown in prescription patterns after clinic review was to one more closely aligned with national guidelines for both COPD.…”

Section: Discussionmentioning

confidence: 99%

Managing complex respiratory patients in the community: an evaluation of a pilot integrated respiratory care service

et al. 2016

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IntroductionIn the UK, there is significant variation in respiratory care and outcomes. An integrated approach to the management of high-risk respiratory patients, incorporating specialist and primary care teams' expertise, is the basis for new integrated respiratory services designed to reduce this variation; however, this model needs evaluating.MethodsTo evaluate an integrated service managing high-risk respiratory patients, electronic searches for patients with asthma and chronic obstructive pulmonary disease at risk of poor outcomes were performed in two general practitioner (GP) practices in a local service-development initiative. Patients were reviewed at joint clinics by primary and secondary care professionals. GPs also nominated patients for inclusion. Reviews were delivered to best standards of care including assessments of diagnosis, control, spirometry, self-management, education, medication, inhaler technique and smoking cessation support. Follow-up of routine clinical data collected at 9-months postclinic were compared with seasonally matched 9-months prior to integrated review.Results82 patients were identified, 55 attended. 13 (23.6%) had their primary diagnosis changed. In comparison with the seasonally adjusted baseline period, in the 9-month follow-up there was an increase in inhaled corticosteroid prescriptions of 23.3%, a reduction in short-acting β2-agonist prescription of 33.3%, a reduction in acute respiratory exacerbations of 67.6%, in unscheduled GP surgery visits of 53.3% and acute respiratory hospital admissions reduced from 3 to 0. Only 4 patients (7.3%) required referral to secondary care. Health economic evaluation showed respiratory-related costs per patient reduced by £231.86.ConclusionsPatients with respiratory disease in this region at risk of suboptimal outcomes identified proactively and managed by an integrated team improved outcomes without the need for hospital referral.

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Accuracy of diagnosis and classification of COPD in primary and specialist nurse-led respiratory care in Rotherham, UK: a cross-sectional study

Cited by 27 publications

References 32 publications

Geographic Accessibility of Pulmonologists for Adults With COPD

Geographic Accessibility of Pulmonologists for Adults With COPD

The recording and characteristics of pulmonary rehabilitation in patients with COPD using The Health Information Network (THIN) primary care database

Managing complex respiratory patients in the community: an evaluation of a pilot integrated respiratory care service

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