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COPD case-finding 'may be waste of money'

By Nigel Praities

Government plans for all practices to proactively search for new cases of COPD risk being a ‘waste of money', GP researchers have told Pulse.

The claims come after a pioneering PBC scheme in Norfolk found case-finding by practices was not as successful as opportunistic screening of adults in supermarkets and bingo halls.

They found holding public events and screening smokers and those with symptoms of COPD identified more patients with COPD and cost significantly less than conventional case-finding by GPs.

The figures cast doubt on plans to roll-out case-finding for COPD in the National Strategy for COPD, due for publication later this year.

Pulse revealed earlier this month the strategy is set to include plans for practices to target potential cases of COPD and for pilots of screening in young adults and children.

The DH is drawing up a list of symptoms ‘suggestive of COPD' for practices to target their case-finding, but this new research casts doubt on this approach.

The case-finding scheme in three practices included sending letters to 3,000 patients on smoking registers asking about whether they had symptoms such as cough and shortness of breath, and enquiring if they wanted advice on smoking cessation.

This strategy was compared with a scheme where eight public events were advertised and 15,000 patients were screened for smoking status and COPD symptoms.

The researchers have recently analysed their findings, which show the public events cost around £280 per case of COPD found, compared with £765 for the case-finding by practices.

Dr Richard Gilbert, a respiratory GPSI in Norfolk, said they only had a 30% response rate to letters from practices and this contributed to the surprising results.

‘It is going to be really important that case-finding is piloted properly and evaluated before it is rolled out, because you could waste an awful lot of time and money doing it in inappropriate ways,' he said.

Dr Gilbert said he was planning a further pilot where spontaneous screening for COPD would take place in practices, and would be submitting his results to East of England SHA – the lead SHA for the National Strategy.

Dr Iain Small, chair of the General Practice Airways Group and a GP in Peterhead, Aberdeenshire, said the research highlighted a major issue.

‘Patients really don't want to engage with this, because they know full well after spirometry someone is going to tell them to stop smoking.

‘In order to make this happen I suspect we need some form of a hybrid system whereby you use intelligent population screening, case-finding but not in a practice,' he said.

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