Abstract
Background COPD is a major UK healthcare cost. Differing standards of care exist e.g.those qualifying for payment;Quality & Outcomes Framework (QOF) vs. the non-incentivised NICE guidelines.
Aims To define a large UK wide COPD cohort and describe their primary care management compared to these standards.
Methods We interrogated thePatient Outcomes and Information Service (POINTS) database of participating practices in the UK. POINTS provided by GlaxoSmithKline UK Ltd as a service to medicine is delivered by Quintiles Data was collected between 2007-08 and 2009-10.
Results 1265 GP Practices had a list size of 7million with 160000 COPD patients. 911 practices returned total list sizes (1.7% prevalence of COPD) 51,000 (32%) had a COPD review recorded yet 85000 (53%) had spirometry recorded within 15 months, 124600 had flu and/or pneumococcal vaccination status recorded (82%) yet only 15% had exacerbation frequency recorded. Increases in MRC dyspnoea score (MRCD) recording occurred from 2007 at 28% to 44% in 2009 (p<0.001). The most common prescription was short acting β agonist SABA in 67%, ICS/LABA combi- inhaler in 47%, LAMA in 30%. 24,000 (15%) were prescribed an ICS inhaler (out of licence and against NICE guidelines). 19000 patients with mild airflow limitation were on ICS-LABA beyond licence (FEV1 60-80%). We found 10,000 potentially misdiagnosed patients with FEV1>80%; of these 38% were on ICS-LABA and 20% were on LAMA.
Conclusions Overtreatment of mild COPD with ICS-LABA or LAMA is frequent. Exacerbations rates were poorly recorded suggesting incomplete COPD reviews that may lead to failure of appropriate management. Exacerbation frequency recording should be incorporated into QOF pay.
- © 2012 ERS