Opportunities to diagnose chronic obstructive pulmonary disease in routine care in the UK: a retrospective study of a clinical cohort

Jones, Rupert; Price, David; Ryan, Dermot; Sims, Erika J.; Ziegenweidt, Julie von; Mascarenhas, Laurence; Burden, Anne; Halpin, David; Winter, Robert J.; Hill, Sue; Kearney, Matt; Holton, Kevin; Moger, Anne; Freeman, Daryl; Chisholm, Alison; Bateman, Eric D.

doi:10.1016/s2213-2600(14)70008-6

Cited by 163 publications

(148 citation statements)

References 40 publications

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“…Estimates by the Department of Health in the UK indicate that approximately 2.2 million people are still undiagnosed [1].This has been corroborated by a recent study, which showed that the chances of early diagnosis of COPD by doctors in the UK have been missed in 85% of cases in the five years before the actual diagnosis [41]. In the USA, 12.7 million people have COPD.…”

Section: Discussionmentioning

confidence: 91%

Impact of community pharmacists in COPD management: Inhalation technique and medication adherence

Hesso

Nabhani‐Gebara

Kayyali

2016

Respiratory Medicine

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Section: Discussionmentioning

confidence: 91%

Impact of community pharmacists in COPD management: Inhalation technique and medication adherence

Hesso

Nabhani‐Gebara

Kayyali

2016

Respiratory Medicine

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“…Quantitative studies Sp1,Sp2,Sp16,Sp19,Sp52,Sp54,Sp55,Sp62,Sp63,Sp87 Sp8,Sp9,Sp15,Sp43,Sp75,Sp87,Sp89,Sp90,Sp92,Sp97 Sp6,Sp14,Sp16,Sp18,Sp27,Sp36,Sp47,Sp49,Sp55,Sp60,Sp61,Sp64,Sp88,Sp100 Sp2,Sp57,Sp59,Sp68,Sp108 Qualitative studies…”

Section: Sp21mentioning

confidence: 99%

Evidence for models of diagnostic service provision in the community: literature mapping exercise and focused rapid reviews

Chambers

Baxter

Johnson

et al. 2016

Health Serv Deliv Res

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BackgroundCurrent NHS policy favours the expansion of diagnostic testing services in community and primary care settings.ObjectivesOur objectives were to identify current models of community diagnostic services in the UK and internationally and to assess the evidence for quality, safety and clinical effectiveness of such services. We were also interested in whether or not there is any evidence to support a broader range of diagnostic tests being provided in the community.Review methodsWe performed an initial broad literature mapping exercise to assess the quantity and nature of the published research evidence. The results were used to inform selection of three areas for investigation in more detail. We chose to perform focused reviews on logistics of diagnostic modalities in primary care (because the relevant issues differ widely between different types of test); diagnostic ultrasound (a key diagnostic technology affected by developments in equipment); and a diagnostic pathway (assessment of breathlessness) typically delivered wholly or partly in primary care/community settings. Databases and other sources searched, and search dates, were decided individually for each review. Quantitative and qualitative systematic reviews and primary studies of any design were eligible for inclusion.ResultsWe identified seven main models of service that are delivered in primary care/community settings and in most cases with the possible involvement of community/primary care staff. Not all of these models are relevant to all types of diagnostic test. Overall, the evidence base for community- and primary care-based diagnostic services was limited, with very few controlled studies comparing different models of service. We found evidence from different settings that these services can reduce referrals to secondary care and allow more patients to be managed in primary care, but the quality of the research was generally poor. Evidence on the quality (including diagnostic accuracy and appropriateness of test ordering) and safety of such services was mixed.ConclusionsIn the absence of clear evidence of superior clinical effectiveness and cost-effectiveness, the expansion of community-based services appears to be driven by other factors. These include policies to encourage moving services out of hospitals; the promise of reduced waiting times for diagnosis; the availability of a wider range of suitable tests and/or cheaper, more user-friendly equipment; and the ability of commercial providers to bid for NHS contracts. However, service development also faces a number of barriers, including issues related to staffing, training, governance and quality control.LimitationsWe have not attempted to cover all types of diagnostic technology in equal depth. Time and staff resources constrained our ability to carry out review processes in duplicate. Research in this field is limited by the difficulty of obtaining, from publicly available sources, up-to-date information about what models of service are commissioned, where and from which providers.Future workThere is a need for research to compare the outcomes of different service models using robust study designs. Comparisons of ‘true’ community-based services with secondary care-based open-access services and rapid access clinics would be particularly valuable. There are specific needs for economic evaluations and for studies that incorporate effects on the wider health system. There appears to be no easy way of identifying what services are being commissioned from whom and keeping up with local evaluations of new services, suggesting a need to improve the availability of information in this area.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…Jones et al found that opportunities to diagnose COPD at early stages are being missed several years ahead of diagnosis. They emphasize the importance of prioritizing educating of nurses and doctors to identify people at risk (including comorbidity) and patients with lower respiratory symptoms, so spirometry can be performed early on [26]. …”

Section: Discussionmentioning

confidence: 99%

Lack of awareness towards smoking-related health risks, symptoms related to COPD, and attitudinal factors concerning smoking: an Internet-based survey conducted in a random sample of the Danish general population

Sikjær

Hilberg

Fløe

et al. 2018

European Clinical Respiratory Journal

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Background: Although chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality globally, several studies have shown little awareness of COPD in the general population. The awareness of COPD in the Scandinavian countries is, however, sparsely investigated. Objective: The aim of this study was to explore the awareness in the general Danish population of smoking-related health risks and symptoms related to COPD and attitudinal factors concerning smoking. Design: Adults aged 18 years or older were randomly selected to reflect the background population. An Internet-based questionnaire was conducted in January–February 2015. Results: A total of 1002 answered the questionnaire (515 males; 487 females). In total, 17.7% were current smokers (men: 15.5%–women: 19.9%). More smokers and ex-smokers knew the symptoms of COPD compared to never-smokers (p < 0.001). Ex-smokers had undergone more pulmonary function tests than smokers and never-smokers (p < 0.001) and significantly more men than women who had undergone pulmonary function test.Ex-smokers were more likely to rate cancer as the most feared disease (p = 0.026) than the smokers. Of the smokers, 28% did not regard COPD as a deadly disease and significantly more smokers than ex-/never-smokers believed that smoking cessation should not be mandatory before treatment of COPD and asthma (p < 0.001). Conclusion: Overall, smokers, ex-, and never-smokers had little knowledge of COPD regarding aetiology, symptoms, and severity thus emphasizing the necessity of early detection of COPD and more focus on spirometry in general practice, especially amongst smokers.There is a great discrepancy between the attitude of smokers and ex-/never-smokers towards mandatory smoking cessation before receiving treatment of smoking-related diseases. Funding: GlaxoSmithKline Pharma A/S Brøndby, financially supported the collecting of data by Voxmeter A/S. The authors had full access to the raw data and did not receive any financially support.

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Opportunities to diagnose chronic obstructive pulmonary disease in routine care in the UK: a retrospective study of a clinical cohort

Abstract: UK Department of Health, Research in Real Life.

Cited by 163 publications

References 40 publications

Impact of community pharmacists in COPD management: Inhalation technique and medication adherence

Impact of community pharmacists in COPD management: Inhalation technique and medication adherence

Evidence for models of diagnostic service provision in the community: literature mapping exercise and focused rapid reviews

Lack of awareness towards smoking-related health risks, symptoms related to COPD, and attitudinal factors concerning smoking: an Internet-based survey conducted in a random sample of the Danish general population

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