Background COPD is a major healthcare burden in the UK with one million diagnosed patients. Despite a number of evidence-based guidelines, managing COPD is not straightforward. Differing standards of care exist; those qualifying for Quality & Outcomes Framework QOF versus Non-incentivised NICE guidelines.
Aims To define a large UK wide COPD cohort and describe their current care as recorded in primary care databases.
Methods We interrogated the POINTS1 database of all participating practises in the UK. Data were collected between 2007and 2009.
Results 1406 GP Practices participated with total list size ∼7.9 million of these ∼180 000 COPD patients were listed. 1009 practices returned list sizes giving approximately 1.8% prevalence of COPD. Approx 45 000 (25%) were current smokers of these ∼31 000 (69% of smokers) had received recent smoking cessation education 30% were of working age (<65 years). 96 000 (50%) had a FEV1 recorded within 12 months, 147 000 had flu and/or pneumococcal vaccination status recorded (80%). Only 15% (27500) had exacerbation frequency recorded. Progressive increases in MRC dyspnoea score (MRCD) recording occurred each year from 2007 at 29% to 44% in 2009. The most common prescription was short acting β agonist SABA in 66%, Inhaled corticosteroid/Long acting β agonist (ICS/LABA) combination inhaler in 47%, LAMA (long acting muscarinic antagonist) in 30%. We noted 27 514 (15%) were prescribed an ICS inhaler which is out of licence and against NICE guidelines. 6% were prescribed a mucolytic.
Conclusions This cohort is one of the largest reported. Certain limitations may apply: possible non-random participation of practises, incorrect COPD diagnosis and incomplete datasets. Despite exacerbation rate reduction being a key management goal, exacerbations are poorly recorded suggesting COPD reviews are poorly conducted/documented. This may lead to failure to increase maintenance regimens. Longitudinal assessment noted rapid increase in MRCD recording after this became remunerable under QOF. Exacerbation frequency recording should be incorporated into QOF. This dataset sets a baseline from which effectiveness of the National Clinical Strategy can be measured.
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