P232 The early detection of chronic obstructive pulmonary disease

Abstract

lung cancer; 2 via the general chest clinics and 1 following re-referral with persistent haemoptysis. Conclusion We have shown that almost a quarter of RALC referrals did not adhere to strict referral protocols and would have been better served by a more appropriate referral elsewhere. We are working to educate our primary and secondary care colleagues to ensure that the only appropriate cases are referred to the RALC in order to reap the maximum benefit from this resource intensive service. P231AUDIT Table 1). The proportion given oxygen fell from 31% in the initial 4 weeks to 24% in the final 5 weeks of the audit when feedback was given to ambulance teams. The "ideal" figure for these cases was about 21% based on JRCALC guidance. 86% of cases were treated in accordance with JRCALC guidance in terms of receiving or not receiving oxygen and 73% were treated in full compliance (correct device and flow rate). The overall compliance rate was 4.4% higher (95% CI e2.3% to 11.0%) during the feedback period and full compliance rose by 9.9% (95% CI 1.6 to 18.2%) following feedback. Eight percent of cases received oxygen inappropriately and 3% were denied oxygen inappropriately. Our audit revealed that NWAS ambulance crews were unable to give controlled oxygen to COPD cases because Venturi masks were not carried. Several COPD cases received high dose oxygen from nebuliser masks throughout the journey because air driven nebulisers and nasal cannulae were not available. Only four of 14 cases with AECOPD had SpO 2 <88% but 12 were given oxygen and 10 developed SpO 2 >92%. Introduction Approximately 835 000 people in England have been diagnosed with COPD however it is estimated that over 3 million have the disease 1 and those cases that are diagnosed are mainly moderate or severe in nature.2 The direct cost of COPD to the UK healthcare system is estimated to be between £810m and £930 m per annum 3 and without change is set to grow Methodology It is essential that we offer good quality early diagnosis but the numbers involved are huge so a screening programme and pathway were developed. Patients at risk of COPD were initially defined as being aged over 40 with a smoking history. Vitalograph COPD6 devices, which measure FEV 1 were used across 22 practices to screen the target population at an average test time of 5 min compared to full spirometry of 20 min. All abnormal results were followed up with full spirometry, performed by an accredited health care provider. Results To date 2055 patients have been screened. 841 (41%) demonstrated an abnormal result on COPD6 screening. Of these so far 376 have had COPD confirmed by spirometry. That is 18.3% of the target population and 45% of the group who had abnormal COPD6 results. It is estimated that, nationally over 2 million people have undiagnosed COPD and of those over 50% are diagnosed with moderate to severe disease 2 however the results available to date suggest that early detection leads to the majority of patients being identified while their condition is still mild. Results...

Effect of Primary Care on Reducing Rates of Hospitalization Among Chronic Obstructive Pulmonary Disease Patients

“…In contrast to general practitioners in wealthy areas, those in impoverished communities have lesser general practitioners, lesser practice nurses, a greater workload for chronic obstructive pulmonary disease, and lower economic advantages. Calderón-Larraaga et al have demonstrated this (28). There hasn't been much progress since Tudor Hart said in 1971 that the requirement for the community addressed appears to fluctuate inversely with the accessibility of effective medical treatment.…”

Identification of chronic respiratory diseases and their risk factors during health survey of the adult population: Methodological aspects

“…И хотя вмешательство по отказу от курения должно быть предложено всем курящим, независимо от наличия обструктивных нарушений, пациенты с высоким риском развития ХОБЛ и уже сформировавшейся об-струкцией легкой или средней степени должны быть идентифицированы для более целенаправленных вмеша-тельств по поводу отказа от курения, ежегодных вакцина-ций от гриппа и коррекции других факторов риска ХОБЛ. Доказано, что затраты на лечение ХОБЛ легкой степени на 50% меньше, чем затраты на лечение ХОБЛ средней степени тяжести и на 90% ниже затрат на лечение тяжелой ХОБЛ [32].…”

Hospital admission rates for COPD: the inverse care law is alive and well

“…Case studies such as the St Health primary care commissioning group have shown improved detection rates and the proportion of patients adjudged to be receiving guideline-based management has risen dramatically from 32% to 85%. Admission rates have declined by 9.2% compared with a rise of 2.3% in adjacent practices 10. Clearly caution is needed when interpreting the changes in admission rates before and after an intervention as they are prone to bias.…”

“…As et al have demonstrated, deprived areas have fewer GPs, fewer practice nurses, a higher workload for COPD but with less financial reward than for GPs in affluent areas 10. Little change then from 1971 when Tudor Hart stated that the availability of good medical care tends to vary inversely with the need for the population served.…”