ASSIST study: Improving COPD diagnosis through primary care and Improving 'complex case' management models of care for people at high risk of admission

Theme 1

Integrated Respiratory Care

Chronic Obstructive Pulmonary Disease (COPD) is a disease of the lungs which is generally caused by smoking tobacco. It is a largely preventable disease that causes severe and irreversible damage to the lungs. If not detected early, this damage will progress causing significant breathing difficulties, disability and poor survival rates. Patients with COPD can experience flare ups or exacerbations of their disease, worsening their symptoms and causing a decline in lung function.

COPD is a global health concern and it is estimated to become the third leading cause of death by 2020. In the United Kingdom, around 900,000 people have a formal diagnosis of COPD. However, it is believed that over 2 million more people may be living with the disease and are unaware that they have it. The cost of treating lung disease in the National Health Service (NHS) is estimated to be approximately £4.7billion per year. The majority of these costs are caused by a small group of COPD patients with severe disease and complex problems. Late diagnosis has been proven as a contributing factor to the worsening of COPD, disease progression and increased healthcare costs. Indeed, recent research has shown that patients may attend their general practitioner (GP) surgery with signs of the disease up to five years before they have the condition diagnosed. A delay in diagnosis is known to hasten the decline in lung function and worsen disease severity making treatment options less useful in the long term. This has led to national guidelines recognising that patients with COPD need to be diagnosed and treated effectively at the earliest opportunity.

The aim of this study is to find the best way to identify or ‘case find’ patients who have not yet been diagnosed with COPD, and also identify patients with more complex disease using a computerised search programme. The study will examine whether this intervention has saved the NHS money in terms of reducing health care visits and decreasing rescue medicine usage for respiratory problems. This data will be compared to patients in similar GP practices where the intervention had not been implemented. Patient records for the previous 12 month prior to the intervention will also be checked to see whether there has been an improvement to health outcomes for participating patients following the intervention. GP practices will also be invited to participate in a tailored training package in order to support this work. Feedback from the practice staff will be sought following the intervention, and from patients newly diagnosed with COPD to understand their experiences and needs.

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Partners on this project
  • University of Southampton
  • Hampshire Hospitals NHS Foundation Trust
  • NHS West Hampshire CCG