Over 1,600 former or current smokers with no history of COPD were identified at two general practices in the West Midlands and either targeted systematically – by sending out respiratory questionnaires by post – or opportunistically given the questionnaires when they visited the surgery.
Over a three to six month period, 10 patients in the targeted arm, and six patients in the opportunistic arm, were diagnosed with COPD – with the difference between the two groups non-significant. When the data was extrapolated over a full year, opportunistic case finding diagnosed more patients with COPD, with a number needed to screen of 51. Opportunistic case finding was also cheaper than the targeted methodology – costing £242.20 and £424.56 per diagnosis respectively.
What does it mean for GPs?
The authors concluded that there was no significant difference in case finding between an opportunistic and a targeted approach to case finding for COPD, but that opportunistic finding was more cost-effective. They also found the cost-effectiveness of the opportunistic approach could be further improved by ensuring patients attended for spirometry.
Dr Rupert Jones, GPSI in respiratory medicine and COPD, and lead of the respiratory research unit at the Universities of Exeter and Plymouth: ‘This study shows that a reasonable yield can be obtained from both targeted postal and opportunistic questionnaires, though this is relatively low given the prevalence of COPD being estimated around 1% to 2% of the adult population in QOF data.
‘I think the main problem with targeted finding is the workload to set it up and run it, whereas the opportunistic method relies on the enthusiasm of the clinicians in handing out questionnaires.’