Research aims and questions
The aim of this proposed research is to understand primary care (GP, nurse, and practice manager) perspectives on case finding for COPD in their practice.
1. To explore GP, nurse and practice manager views on the estimated under diagnosis of COPD.
2. To explore GP, nurse and practice manager views on the extent to which the under diagnosis of COPD exists and whether addressing it is a priority in their practice.
3. To explore GP and nurse personal accounts of triggers to initiating investigations to diagnose COPD.
4. To explore GP, nurse and practice manager views on case finding in their practice including barriers and facilitators to case finding e.g. resource availability and competencies.
5. To explore perceived influences to earlier diagnosis of COPD within primary care, amongst GPs, nurse and practice managers.
Start date: 2 August 2015
End date: 31 August 2016
Outputs – Publications:
Managing complex respiratory patients in the community: an evaluation of a pilot integrated respiratory care service: https://bmjopenrespres.bmj.com/content/3/1/e000145.full
· Approximately 60% of patients seen met the criteria for a new respiratory diagnosis facilitating them access to appropriate symptom management.
· An additional 10% of patients seen had a non-respiratory diagnosis suggested.
· 23% of patients seen received a change in diagnosis.
· 70% of patients seen received a change in medication.
· At six month follow up, patients were found to have a significant improvement in disease control and decreased hospitalisation rate.
· Nearly a quarter of patients had their original diagnosis changed, allowing them to access more appropriate disease treatment.
· In the six months after the clinic, patients required 79% less emergency GP appointments, 29% less routine GP appointments and 48% less Practice Nurse appointments compared to the six months before the clinic.
· Health economic analysis showed respiratory related costs per patient over a 9 month period decrease by £231.86 per patient, equating to an annualised saving of £309.15. The overall cost of the intervention for the patients seen in both practices was £296.82 per patient suggesting the intervention was almost cost neutral after only nine months.
· Feedback from patients was 100% positive from all clinics both in terms of patient experience of the clinic and the interventions made.
· Development of this pilot study was done in collaboration with the West Hampshire Clinical Commissioning Group (CCG) and Wessex Academic Health Sciences Network (WAHSN). As well as raising the profile and awareness of asthma and COPD across these groups, the WAHSN matched funding thereby providing 50% of the cost of the pilot study
· The results of the pilot study have provided a springboard for collaboration with NIHR-funded research groups in Birmingham and Imperial College, London in the development of the next phase of the research project.