Initial diagnosis and management of chronic obstructive pulmonary disease in Australia: views from the coal face

Bereznicki, Bonnie; Walters, E. Haydn; Walters, Julia; Peterson, Gregory M.; Bereznicki, Lre

doi:10.1111/imj.13418

Cited by 6 publications

(5 citation statements)

References 38 publications

(81 reference statements)

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“… 32 Recent data in primary care reiterate systematic issues in the Australian primary care setting, such as a reactive and relatively delayed approach to diagnosis. 33 Although cost-effectiveness analysis of the case-finding protocol was not attempted, our use of pharmacy-delivered microspirometry (instead of conventional spirometry), referring only those with high risk of COPD for onward GP review and diagnosis (instead of physicians undertaking the entire process from screening to diagnosis), the brevity of the case-finding protocol and the online modes (instead of face to face) of pharmacist training may render this model of COPD case detection more economic than conventional GP-based screening models where the onus of identifying, screening and testing potential COPD cases falls entirely upon the increasingly busy practices. In support of this, pharmacists’ confidence in providing the service, including microspirometry and their fidelity to the study protocol, was high.…”

Section: Discussionmentioning

confidence: 99%

Community pharmacy-based case finding for COPD in urban and rural settings is feasible and effective

Fathima

Saini

Foster

et al. 2017

COPD

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Background and objectiveCase finding of patients at risk of COPD by community pharmacists could identify a substantial number of people with undiagnosed COPD, but little is known about the feasibility and effectiveness of pharmacy-based COPD case finding using microspirometry. The objective of this study was to assess the feasibility and effectiveness of COPD case-finding service provided by community pharmacists, utilizing a combination of risk assessment questionnaire and microspirometry.MethodsA 6-month service was conducted in 21 community pharmacies in Australia. Pharmacists trained in COPD case finding, including lung function test (LFT), invited their patients aged ≥35 years with a history of smoking and/or respiratory symptoms to participate. High-risk patients were identified via a COPD risk assessment questionnaire (Initial Screening Questionnaire [ISQ]) and underwent LFT. Pharmacists referred patients with a forced expiratory volume in 1 second (FEV1)/forced expiratory volume in 6 seconds (FEV6) ratio <0.75 to their general practitioner (GP) for further assessment and diagnosis.ResultsIn all, 91 of 167 (54%) patients had an ISQ score >3 indicating high COPD risk. Of the 157 patients who were able to complete LFT, 61 (39%) had an FEV1/FEV6 ratio of <0.75 and were referred to their GP. Patients with high ISQ symptoms scores (>3) were at a significantly higher risk of an FEV1/FEV6 ratio of <0.75, compared to patients with fewer COPD symptoms. A total of 15 (10%) patients were diagnosed with COPD by their GP. Another eight (5%) patients were diagnosed with other medical conditions and 87% of these were initiated on treatment. Although only half of all screened patients lived in regional areas, 93% of those diagnosed with COPD were from regional areas.ConclusionA brief community pharmacy-based COPD case-finding service utilizing the ISQ, LFT and GP referral is feasible and may lead to identification and diagnosis of a substantial number of people with COPD. This might be an important strategy for reducing the burden of COPD, particularly for those living in rural locations.

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Section: Discussionmentioning

confidence: 99%

Community pharmacy-based case finding for COPD in urban and rural settings is feasible and effective

Fathima

Saini

Foster

et al. 2017

COPD

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“…Variability of adherence and barriers to implement guidelines due to various reasons including unfamiliarity with recommendation, concerns of underlying evidence and applicability have been identified in prior research with little apparent improvement over time [ 16 – 18 ]. This is a concerning issue warranting further understanding and action and supported by previous Australian studies [ 19 , 20 ]. It is vital to identify (a) specific barriers to adhere/implement guidelines and (b) preferences for interventions to improve adherence among target users [ 17 , 21 ].…”

Section: Discussionmentioning

confidence: 57%

General practice care following acute exacerbations of COPD: A survey of Australian general practitioners

2023

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Acute exacerbations of COPD (AECOPDs) are one of the leading causes of preventable hospital admissions in Australia. Exacerbations are the strongest predictor for future exacerbations. The period immediately following an exacerbation is a high-risk period for recurrence and critical time to intervene. The aim of this study was to identify current general practice care for patients following an AECOPD in Australia and gain insights into knowledge of evidence-based care. A cross-sectional survey was created and disseminated electronically to Australian general practitioners (GPs). Data were analysed descriptively. Comparisons between groups were made using Chi squared tests. From 64 responses, 47% were familiar with the COPD-X Plan. Only 50% described reviewing patients within seven days of discharge mostly related to a lack of awareness of the hospital admission. 50% of surveyed GPs reported hospital discharge summaries did not provide the information they required. Smoking, immunisation and medications were regularly assessed by >90% respondents at follow-up visits, while referrals to pulmonary rehabilitation, and evaluation of spirometry and oxygen therapy were not prioritised. GPs appear to require support to increase their familiarity with COPD guidelines and inform evidence-based clinical practice. The handover/communication process from hospital to primary care appears an important area for future improvement.

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“…This study highlights a necessity for GPs to maintain familiarity with evidence-based guidelines. This is supported by prior national and international studies with little apparent improvement over time (46)(47)(48)(49)(50). Additional support is likely indicated to ensure clinical practice is evidence informed.…”

Section: Implications For Research And/or Practicementioning

confidence: 87%

General practice management of COPD patients following acute exacerbations: a qualitative study

Perera

Barton²,

Osadnik³

2022

Br J Gen Pract

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Background: Exacerbations are the strongest risk factor for future exacerbations for patients living with chronic obstructive pulmonary disease (COPD). The period immediately following exacerbation is a high-risk period for recurrence and hospital admission and is a critical time to intervene. General practitioners (GPs) are ideally positioned to deliver this care. Aim: To explore perceptions of GPs regarding the care of patients following exacerbations of COPD and to identify factors affecting the provision of evidence-based care. Design and setting: A descriptive qualitative study was undertaken involving semi-structured in-depth interviews with Australian GPs who volunteered to participate following a national survey of general practice care for COPD patients following exacerbations. Method: Interviews were conducted via Zoom video conference platform, audio recorded and transcribed verbatim. QSR NVivo was used to support data management, coding, and inductive thematic analysis. Results: Eighteen GPs completed interviews. Six key themes were identified: (1) GPs’ perceptions and knowledge in the management of COPD patients following exacerbation and hospitalisation; (2) Consultation time; (3) Pharmacological management; (4) Communication between healthcare professionals and (5) Access to other health services; (6) Patient compliance. Conclusion: Delivery of post-exacerbation care to COPD patients is affected by GPs, patients, and health servicerelated factors. The care of COPD patients may be further improved by supporting GPs to overcome identified barriers.

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Initial diagnosis and management of chronic obstructive pulmonary disease in Australia: views from the coal face

Cited by 6 publications

References 38 publications

Community pharmacy-based case finding for COPD in urban and rural settings is feasible and effective

Community pharmacy-based case finding for COPD in urban and rural settings is feasible and effective

General practice care following acute exacerbations of COPD: A survey of Australian general practitioners

General practice management of COPD patients following acute exacerbations: a qualitative study

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