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QOF: How does your practice measure up in COPD management?

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A recent report has concluded that there are improvements needed in primary care in provisions for COPD diagnosis and treatment. Especially, these improvements should reduce costs by removing unnecessary treatment given to patients who don't have COPD. The report analysed QOF and PHE data from England's GP practices during 2014/15. It found that high QOF scores have given 'false assurance' on the quality of COPD services.

How big is the COPD issue?

In the UK, there are 1.2 million people that have been diagnosed with COPD. It is the second most common disease of the lungs in the UK, and responsible for 30,000 deaths every year.

The report "Primary care: COPD in England – finding the measure of success", which was commissioned in 2013 by the Royal College of Physicians and published in November 2016, found that:

  • Clinically and cost-effective treatments are underused
  • Accurate and early diagnosis of COPD must be prioritised

Dr Noel Baxter, the clinical lead for the RCP's primary care workstream said, "It will come as no surprise to people working in and with general practice who are interested in outcomes for people with COPD that the high achieving QOF results have provided false assurance about the quality of care for these people."

He recommends that CCGs look at their local data and get "serious about measuring the quality of care for people with COPD."

What should primary care do to diagnose COPD?

Look for the symptoms of COPD, particularly patients over the age of 35 who have a high-risk factor (especially smoking). If one or more of the following symptoms are present, then you should consider spirometry testing for COPD:

  • Exertional breathlessness
  • Chronic cough
  • Regular sputum production
  • Frequent winter 'bronchitis'
  • Wheeze

Ask about:

  • Weight loss
  • Effort intolerance
  • Waking at night
  • Ankle swelling
  • Fatigue
  • Occupational hazards
  • Chest pain

Other diagnosis tests include chest radiographs (to exclude other pathologies), blood counts, and BMI measurements.

Treatments for COPD

The report says that the following interventions should be offered:

  • Tobacco dependence treatment, which is safe, effective, and cost-effective
  • Pulmonary rehabilitation
  • Inhaler treatment

For patients who also have hypoxia, long-term oxygen therapy is a life-prolonging intervention.

In conclusion, the report says that primary care must improve its coding and recording of COPD consultations, prescribing, and referrals. Patients should be encouraged to "know their numbers", and better understand their condition. This will enable them to self-monitor their condition, and increase their ability to manage their own care and action plans.

Is your practice following the best processes and practices in diagnosis and treatment of COPD?

Download the COPD report to read its findings in full detail.

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