Tackling COPD misdiagnosis in primary care through integrated care

Abstract

Background: COPD specific integrated care services have in the past been shown to improve patients’ outcomes and reduce costs. However, tackling the issue of COPD misdiagnosis within primary care is potentially an additional purpose integrated care can serve. Aim: To determine the prevalence of COPD misdiagnosis in primary care, identified through specialist led integrated care. Methods: Patients on the COPD register at 10 general practices in Birmingham were offered the opportunity to have their annual COPD review completed by a respiratory specialist between 2017 and 2019 as part of the INTEGR COPD study (NCT03482700). Patients who accepted had a clinical and spirometry assessment with the respiratory specialist in their usual general practice. The specialist reviewed spirometry results and reported symptoms to identify possible misdiagnoses. Results: Of the 937 patients on the COPD registers, 697 attended for specialist review. 63 (9%) did not have COPD, of which 26 (44%) had asthma and 22 (35%) had normal spirometry. The most common cause of initial misdiagnosis was misinterpretation of spirometry results in primary care (60%). Causes of misdiagnosis were further explored using qualitative interviews to understand clinician perceptions of misdiagnosis. Conclusions: The diagnosis of COPD should always be questioned during a patient’s annual review in order to reduce misdiagnosis and the harm that comes with it. However, despite having annual spirometry and clinical assessment, within primary care, patients remain misdiagnosed. The implementation of an integrated care service providing specialist support within primary care can help identify and reduce the number of patients misdiagnosed with COPD.