Abstract
Recent data has suggested a high prevalence of Non-CF bronchiectasis (NCFB) in primary care, but evidence is lacking regarding management of patients in this setting.This study sought to establish adherence to the British Thoracic Society (BTS) quality standards (QS) for NCFB in a busy General Practice. Comparison was made to a similar sized cohort of NCFB patients in the local referral hospital.
Patients with NCFB were selected for the study from primary care using the diagnostic code SNOMED H34 in the EMIS database. Secondary care patients were identified from CT thorax reports containing the term bronchiectasis between May and October 2015. Data recorded included demographics and adherence to BTS QS.
65/13000 (0.5%) of patients in primary care had a diagnosis of NCFB with a mean age of 68 and proportion male 35.4%. The median QS achieved was 6/11. Rates of adherence for key QS including physiotherapy, and sputum surveillance, were poor. 41 patients (63%) had been seen by secondary care within 5 years. Co-management did improve adherence to QS parameters including sputum surveillance (36.6% vs 8.3%) and referral for physiotherapy (34.1% vs 12.5%). In the secondary care cohort, 70 cases of NCFB were identified with a mean age of 70 and proportion male 51%. Overall median QS achieved was 7/11. There was improved adherence to the key QS compared to primary care including sputum surveillance (43%) and referral to physiotherapy (46%).
Thisdata suggests there are clear differences in adherence to national guidelines for NCFB between primary and secondary care. These differences could be addressed by the development of an integrated care pathway for NCFB.
- Copyright ©the authors 2016