npj Primary Care Respiratory Medicine (Feb 2021)

Specialist respiratory outreach: a case-finding initiative for identifying undiagnosed COPD in primary care

  • Emma Ray,
  • David Culliford,
  • Helen Kruk,
  • Kate Gillett,
  • Mal North,
  • Carla M. Astles,
  • Alexander Hicks,
  • Matthew Johnson,
  • Sharon Xiaowen Lin,
  • Rosanna Orlando,
  • Mike Thomas,
  • Rachel E. Jordan,
  • David Price,
  • Mita Konstantin,
  • Tom M. A. Wilkinson

DOI
https://doi.org/10.1038/s41533-021-00219-x
Journal volume & issue
Vol. 31, no. 1
pp. 1 – 8

Abstract

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Abstract COPD remains largely undiagnosed or is diagnosed late in the course of disease. We report findings of a specialist outreach programme to identify undiagnosed COPD in primary care. An electronic case-finding algorithm identified 1602 at-risk patients from 12 practices who were invited to attend the clinic. Three hundred and eighty-three (23.9%) responded and 288 were enrolled into the study. Forty-eight (16.6%) had undiagnosed mild and 28 (9.7%) had moderate airway obstruction, meeting spirometric diagnostic criteria for COPD. However, at 12 months only 8 suspected COPD patients (10.6%) had received a diagnostic label in their primary care record. This constituted 0.38% of the total patient population, as compared with 0.31% of control practices, p = 0.306. However, if all patients with airway obstruction received a coding of COPD, then the diagnosis rate in the intervention group would have risen by 0.84%. Despite the low take-up and diagnostic yield, this programme suggests that integrated case-finding strategies could improve COPD recognition.