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Dispensing GPs back reimbursement plans

The number of patients on practice lists with COPD will leap five-fold with the use of new screening questions, a new GP study concludes.

Researchers said using the questions would address 'massive' underdiagnosis of mild to moderate COPD and generate more money through the QOF.

But LMCs questioned whether the extra workload would be feasible.

The rearchers found questions on wheezing, coughing and dyspnoea most accurately identified those with early-stage COPD.

Patients who said they experienced dyspnoea on doing any exercise or at rest were three times as likely to have COPD as those with no dyspnoea, while those with wheezing every day were at a doubled COPD risk.

Professor David Price, one of the study team and a professor of primary care respiratory medicine at the University of Aberdeen, said: 'It's extremely important because we have massive underdiagnosis of COPD.'

Professor Price, a sessional GP in Norfolk, predicted the average practice of 10,000 would find its number of COPD patients increasing from 30 to 150.

'There are some short-term cost issues but the number of patients they're getting QOF points for would change too,' he said, referring to the increase in practice prevalence.

Combining responses to simple yes-no questions detected mild to moderate COPD with a sensitivity of 87.1 per cent and a specificity of 71.3 per cent. Using multiple-choice questions was less sensitive, more specific, but crucially less convenient in a general practice setting.

'In a real-life clinic setting, the simplicity of single responses may outweigh any small advantage in discriminatory power,' concluded the study, published in Respiratory Medicine (October).

Dr Dermot Ryan, a GP

in Loughborough, Leicestershire, and member of the British Thoracic Society, said: 'This will be very, very useful both for health care professionals and the public. In every country in the world COPD is underdiagnosed.'

But Dr Peter Jolliffe, chief officer of Devon LMC, said extra resources would be needed to cope with the extra workload.

'How many more hours would we need a year to do that work? Is that feasible?'

By Daniel Cressey

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