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P118 Quantity And Quality Of Referrals To Pulmonary Rehabilitation From Primary Care Following Inclusion In The Quality And Outcomes Framework (qof) In Wales
  1. J Ayling-Smith1,
  2. M Owen2,
  3. J Byers1,
  4. D Menzies1
  1. 1Glan Clwyd Hospital, Betsi Cadwaladr Health Board, UK
  2. 2Wrexham Maelor Hospital, Betsi Cadwaladr Health Board, UK

Abstract

Introduction Referring suitable patients for Pulmonary Rehabilitation (PR) has formed part of the Quality and Outcomes Framework (QOF) reward for General Practitioners (GPs) in Wales since April 2013. Patients with Chronic Obstructive Pulmonary Disease (COPD) that have a Medical Research Council (MRC) dyspnoea score of 3 or above, or those with an MRC score of 2 and recently discharged from hospital for COPD are eligible. We sought to determine the impact of this change on the referral pattern to our PR programme, which traditionally had only accepted referrals from secondary care respiratory consultants.

Methods A standardised form was prospectively designed and distributed to enable primary care providers to refer suitable patients to the PR programme. Data on patient demographics, respiratory diagnosis, co-morbid conditions, MRC dyspnoea score, exacerbation frequency and current medication were collected. Referring GPs were also asked to provide recent spirometry values for patients that were referred. An assessment was made based on the information provided as to whether the patient could be listed immediately for pulmonary rehabilitation, whether further assessment was required, or whether the referral was inappropriate.

Results A sample of 250 GP referral forms out of a total of 545 were evaluated of which 51% of patients were male and the mean age was 69 years (range 31–90). 40.8% of GP referrals could be listed immediately for PR, 34.8% of referrals needed further assessment and 24.4% were inappropriate. 22.4% of all patients referred did not have COPD based on the spirometry results supplied. Compared with the baseline referral rate to PR from secondary care consultants, the rate of referral from GPs showed a sharp increase, particularly toward the end of the financial year (difference in slope -0.77 (95% CI -2.16 to 0.61) versus 9.53 (6.03 to 13.03), p < 0.0001) [Figure]. 36.8% of patients were found to be on off-label inhaled therapy for COPD.

Conclusion The number of referrals to PR increased significantly following inclusion in QOF. The majority of the referrals from GPs either require further evaluation or are inappropriate. The spirometry data suggests there is a high misdiagnosis rate of COPD in primary care.

Abstract P118 Figure 1

Referrals to pulmonary rehabilitation before and after QoF

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