COPD register errors
COPD registers are riddled with errors with many patients failing to meet criteria for diagnosis under the quality and outcomes framework, a new audit reveals.
Even after excluding coding errors and other diagnostic mistakes, a quarter of patients diagnosed with COPD by spirometry did not actually have the disease, the analysis of more than 600 patients showed.
GPs warned the results highlighted the ongoing confusion over how to diagnose COPD. But the findings will also add weight to calls for the planned national service framework on the disease, announced by the Government last week, to go far beyond current QOF targets.
The researchers identified 919 patients on COPD registers at 14 practices and invited 620 in for assessment, after excluding those unable to attend, with coding errors or with normal spirometry.
Of the 349 patients who attended, 266 had spirometrically confirmed COPD. But 24 per cent had normal, restrictive or reversible spirometry, the researchers told the fifth international multidisciplinary conference on COPD in Birmingham.
Study leader Dr Rupert Jones, head of the respiratory research unit at Peninsula Medical School in Plymouth and a GPSI in COPD, said: 'There is going to be room for improving all the registers. The main things we found were diagnoses of COPD when they have normal spirometry and quite a lot of people turned out to have asthma or other diseases.'
Dr Kevin Gruffydd-Jones, committee member of the General Practice Airways Group and a GP in Box, Wiltshire, said: 'This study illustrates that there is still a great deal of confusion about the diagnosis of COPD which is not helped by the differing advice from QOF and NICE with regard to spirometry.
'There is still a huge variation in the standards of carrying out and interpretation of spirometry in primary care and maybe this can be addressed in the new NSF for COPD.'
Professor Sue Hill, chief scientific officer at the Department of Health, told Pulse the NSF would build on the incentives in the QOF by 'putting the detail' behind it, 'for instance on quality of diagnosis'.
She added: 'It you look at what's in the QOF at the moment it doesn't cover the whole spectrum, it focuses on certain aspects of COPD.'