Welsh COPD Audit Results

It was always intended that the National COPD audit would gather data from primary care as well as from secondary care and pulmonary rehabilitation. However, concerns over the confidentiality of practice level data due to the care.data issues a couple of years ago have led to a block on gathering data from practices in England for the COPD audit. So this first data collection is for practices in Wales only, and presented in a report ‘Time to take a breath’. (more backgroun information on National COPD audit HERE)    

While the National COPD audit has been running for several years, this is the first report based on primary care data to be published. It highlights that many patients may not be receiving care in line with evidence-based guidelines, and that inconsistency in coding COPD interventions in practices makes it hard to get an accurate picture of the care that patients are receiving.

It was always intended that the National COPD audit would gather data from primary care as well as from secondary care and pulmonary rehabilitation. However, concerns over the confidentiality of practice level data due to the care.data issues a couple of years ago have led to a block on gathering data from practices in England for the COPD audit. So this first data collection is for practices in Wales only, and presented in a report ‘Time to take a breath’. (more backgroun information on National COPD audit HERE)    

Key areas for attention include : 

• Recording and quality of diagnosis using spirometry. Four out of five people do not have an appropriate record of the principal diagnostic test for COPD. Of those who had received spirometry, 26.9% had a value that was not consistent with COPD. However, over 60% on COPD registers had a record of a chest X-ray around the time of diagnosis.
• Low recorded use of high value interventions. Two thirds of patients with an MRC breathlessness score making them eligible for pulmonary rehabilitation had never actually been referred to pulmonary rehabilitation. Only 10.8% of current smokers had received any pharmacotherapy to help them quit.  It was encouraging however that almost 75% of patients on COPD registers recorded as ‘current smokers’ had been referred for support to quit.
• Monitoring people effectively so they receive the right treatment.  The number of COPD patients with an MRC breathlessness score recorded in the audit year was 58.2%. In only 10.8% of patients with COPD was an exacerbation coded in 2013-14, which is almost certainly an under-recording. Likewise it is likely that the number of  people on oxygen treatment is under-recorded – only 0.4% of people on COPD registers had a record of receiving oxygen.

       (See a 2 page summary of key findings and recommendations for PCRS-UK members HERE)

When data extracted from practice systems are compared with QOF data for COPD, significant disparities emerge. Dr Noel Baxter, Clinical lead, National COPD Audit Programme Primary Care Workstream, and chair of PCRS-UK commented, ‘Low recording rates could reflect lower standards of care, but also may reflect confusion about appropriate coding. It was hard to tease out exactly what the issue was for some questions.’

Carol Stonham, a nurse practitioner in general practice, a Queen’s Nurse  and nurse lead for PCRS-UK commented, ‘Time to Take a Breath has highlighted the areas of everyday care where primary care can make a difference. Much of it is day to day care, be it diagnosis, annual review or exacerbations, and whilst there are pockets of outstanding care, patients are subjected to too much variability. We all need to look at how the care we offer compares locally and nationally and aspire to be the best.’

Useful Links -

• Time to take a breath – link to RCP report
• Summary of key findings and recommendations for PCRS-UK members HERE
• Background information about the National COPD audit – HERE
• PCRS-UK Quick guide to the diagnosis and management of COPD
• NICE quality standard for COPD
• See latest Primary Care Respiratory Update edition on tobacco dependency (September 2016)
• See PCRS-UK e-alert on September 12 re ‘ Improving the quality of diagnostic spirometry in adults: the National Register of certified professionals and operators’.

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