A project to assess the effectiveness and feasibility of case finding of Chronic Obstructive Pulmonary Disease (COPD) by practice nurses in General Practice
Nick Zwar, Guy Marks, Alan Crockett, Sanjyot Vagholkar, Sarah Dennis
COPD is a leading cause of disability, hospital admission and premature mortality in men and women. Specifically, COPD is the third leading cause of disease burden after ischaemic heart disease and stroke, yet it remains under-diagnosed in Australia. Effective treatment for the condition is available, particularly when combined with smoking cessation, as smoking is a high risk factor for COPD.
General practice is well placed to provide early diagnosis, intervention and management of COPD patients. In Australia, general practice is the most common point of contact with the health system with 87% of people visiting their GP at least once a year. COPD accounts for 0.5% of all problems managed in general practice.
It is in this context that we consider the role of practice nurses in the diagnosis of COPD. The role of practice nurses in Australia is evolving. Only 10% of general practices employ practice nurses, and barriers to increased utilisation include lack of training for practice nurses, and lack of Medicare item numbers for screening by nurses. The role of practice assistants and practice nurses has also been investigated in Dutch and UK studies of COPD diagnosis.
This project investigated the prevalence of COPD diagnosis in an Australian general practice setting, and whether an intervention utilising practice nurses addresses under-diagnosis of COPD. At-risk patients have been identified by a search strategy of clinical records. Other outcomes included the acceptability to patients, GPs and practice staff of this process of case finding, and changes in prevalence of diagnosis of COPD resulting.
The hypothesis is that practice nurse screening of at-risk patients identified by a search of medical records, and using a questionnaire and spirometry is an effective, feasible and acceptable method of diagnosing COPD.
The study combined both quantitative and qualitative methodologies. The study yielded both quantitative data (on prevalence of COPD diagnoses before and after the intervention, number needed to screen, concordance between computer recorded diagnosis and diagnosis within traditional medical records, accuracy of smoking history) and qualitative data (barriers and facilitators of practice nurse role in COPD case finding; patient and general practitioner attitudes to this practice nurse role).