Management of COPD in primary care: an audit of NICE guidance and cost effectiveness

Abstract

Introduction: COPD costs the NHS £800 million annually. Conducting yearly reviews and complying with NICE guidance is estimated to reduce hospital admissions by 5%, resulting in a £15.5 million annual saving. Aims: To ensure patients have had COPD reviews and inhaler technique assessment in the last year. To ensure pharmacological therapy complies with NICE guidance. Method: All COPD patients at a London practice were audited between January 2016 and January 2017. The criteria assessed whether patients had had in the last 12 months: a COPD review; revision of inhaler technique; number of exacerbations; medication prescribed as per NICE guidance. Results: 5060 patients were registered with 51 eligible (practice prevalence of 1%). 73% (n=37) had a COPD review and revision of inhaler technique in the last year. 67% (n=34) had ≥1 exacerbations with 1% (n=4) occurring in hospital. 86% (n=44) were prescribed inhaled or oral steroids, of which 59% (n=26) followed NICE guidance. None were prescribed theophylline. 7 patients were prescribed mucolytics all following NICE guidance. Discussion: Annual reviews occurred for the majority of patients, possibly because these tasks electronically notified the clinician. Assessment of inhaler technique was comprised within the review and thus only completed at this time. Two-thirds of patients experienced exacerbations, of which the majority were correctly managed in primary care. The use of inhaled steroids was poor with 41% deviating from NICE guidance. Conclusion: By undertaking annual reviews and managing COPD within NICE guidance parameters, there is potential for increasing compliance and limiting emergency admissions, which may improve outcomes and reduce financial burden.