Clinic audit on Chronic Obstructive Pulmonary Disease (COPD) management in public primary care setting: Hong Kong experience

Abstract

BackgroundChronic obstructive pulmonary disease (COPD) is a common condition encountered in primary care and presents a substantial burden to the health care system. This study aimed to audit COPD care at all public primary care clinics of Hong Kong and to work out improvement strategies.MethodThe computer record of COPD patients aged 40 or above and had been followed up at any of the 73 public primary care clinics under the Hospital Authority of Hong Kong (HAHK) were reviewed. Evidence-based audit criteria and performance standards were established after thorough literature review. In the first phase from 1st April 2017 to 31st March 2018, deficiencies of care were identified. It was followed by a one-year implementation phase through which a series of improvement strategies were executed. Outcome of the service enhancement was assessed in the second phase from 1st April 2019 to 31st March 2020. Student’s t test and Chi-square test were used to identify any statistically significant changes between the two.ResultsTotally 10,385 COPD cases were identified in Phase 1, among whom 3,102 (29.9%) were active smokers. Most of the patients were male (87.7%) and the mean age was 75.3±9.9 years old. Of those smokers, 1,788 (57.6%) had been referred to Smoking Counselling and Cessation Service (SCCS) and 1,578 (50.9%) actually attended it. 4,866 cases (46.9%) received Seasonal Influenza Vaccine (SIV) and 4,227 cases (40.7%) received Pneumococcal Vaccine (PCV). 1,983 patients (19.1%) had spirometry done before and 1,327 patients (12.8%) had been admitted to hospital due to acute exacerbation of COPD (AECOPD). With the concerted effort taken during the implementation phase, Phase 2 data showed a significant improvement in all criteria. There was a marked increase in the SIV and PCV uptake rate, spirometry performance rate and most importantly, a significant reduction in AECOPD rate leading to hospital admission (9.6%, P<0.00001).ConclusionCOPD care at all public primary care clinics of HAHK had been significantly improved for all audit criteria via the systematic team approach, which in turn reduced the hospital admission rate and helped relieve the burden of the healthcare system.