Is primary care review of COPD adequate

In the UK stable patients with COPD are managed in primary care. NICE guidelines recommend specific criteria are regularly assessed. Method: We conducted a survey of COPD care delivered by all 50 General Practices (GPs) in our catchment area. We assessed compliance with NICE guidelines including frequency of reviews, spirometry, smoking cessation, pharmacological treatment and side effects, long term oxygen therapy (LTOT), pulmonary rehabilitation and nutrition. Results: 30 (60%) GPs completed the survey. All reported regularly reviewing patients with stable COPD, taking an average time of 20minutes. 25 reported biannual or annual reviews, 5 did not state frequency. 26 reviews were conducted by a practice nurse, 1 by GP. Of the practice nurses 1 had completed an Eastern Region Respiratory Course, 18 nurses had completed a COPD diploma, 1 an asthma diploma, 8 had untaken a spirometry course and 1 had undergone no training. 28 practices assessed for side effects of medications whilst 29 reviewed the need for specialist referral and self-management plans. All reported regular assessment of spirometry, smoking status and cessation, symptom control, frequency of exacerbation and inhaler technique. 21 practices reported assessing for LTOT using spirometry and 22 assessed for referral for pulmonary rehabilitation with 3 stating MRC dyspnoea score as basis for referral. 19 practices assessed nutritional status using department of health guidelines and body mass index. Discussion: There is significant variability in the training of staff reviewing patients with stable COPD and in the quality and content of reviews. For reviews to be effective it is essential that they are standardised and carried out by individuals with adequate training for the task.