Breakout 4.1 Finding the missing millions - David Halpin Part of a set of presentations from NHS Improvement event: Better value, better outcomes held on Thursday 21 February 2013, Guoman Tower Hotel, London How to deliver quality and value in chronic care:sharing the learning from the respiratory programme

1. Finding the Missing Millions
• Scale of misdiagnosis and under-diagnosis
• Possible reasons for this
• Opportunities for earlier diagnosis
• Raising awareness
• Encouraging testing
• Opportunistic case finding
• Using practice registers
Finding the Missing Millions
• Scale of misdiagnosis and under-diagnosis
• Possible reasons for this
• Opportunities for earlier diagnosis
• Raising awareness
• Encouraging testing
• Opportunistic case finding
• Using practice registers
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2. Underdiagnosis of COPD
The ratio of diagnosed to
expected prevalence
varied from 0.20 to 0.95,
mean of 0.52.
Underdiagnosis was more
pronounced in urban
areas, and was
particularly severe in
London
Nacul et al. J Pub Health 2010
Atlas of Variation
In Respiratory Healthcare
www.rightcare.nhs.uk/index.php/atlas/respiratorydisease/
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3. Depending on where I live
I am 3 times more likely to
get my COPD diagnosed
inhale Database
www.inhale.nhs.uk/
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4. APHO Data on General Practice
http://www.apho.org.uk/PracProf/
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5. Extent of Underdiagnosis in England
8215 people in Health Survey for England
Spirometry-defined COPD was present in 1093 (13.3%)
Mild in 5.5%, Moderate in 5.8%, Severe or Very severe in 1.9%.
100
90
Respiratory Diagnosis
80
Percentage with a
70 53.2
60 78.7
50 93.6
40
30
20
10
0
GOLD 1 GOLD 2 GOLD 3/4
Shahab et al. Thorax 2006;61:1043–1047
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6. Finding the Missing Millions
• Scale of misdiagnosis and under-diagnosis
• Possible reasons for this
• Opportunities for earlier diagnosis
• Raising awareness
• Encouraging testing
• Opportunistic case finding
• Using practice registers
Finding the Missing Millions
• Scale of misdiagnosis and under-diagnosis
• Possible reasons for this
• Opportunities for earlier diagnosis
• Raising awareness
• Encouraging testing
• Opportunistic case finding
• Using practice registers
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7. Raising Awareness
Raising Awareness
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8. Raising Awareness & Encouraging Testing
Know it. Check it. Treat it.
Using a combination of centrally coordinated and
locally-led activities the campaign aims to:
• Generate HCP endorsement for the campaign
to support doctors, nurses, carers and
community pharmacists when talking to people
about COPD
• Raise awareness of COPD terminology and its
symptoms among the target audience
• Help people link their symptoms (and those of
people they care for) to the disease in order to
drive patient presentations
• Demonstrate the positive health benefits that
can be gained if people seek help and offer a
clear route for getting help
• Illustrate the benefits of optimal COPD care for
those already diagnosed but who are still
breathless
Raising Awareness & Encouraging Testing
Know it. Check it. Treat it.
Salford
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9. Finding the Missing Millions
• Scale of misdiagnosis and under-diagnosis
• Possible reasons for this
• Opportunities for earlier diagnosis
• Raising awareness
• Encouraging testing
• Opportunistic case finding
• Using practice registers
Pilot Study of Case Finding
for COPD in Honiton
• Random sample of 100 patients attending surgery
• Age 45+
• Mixed urban/rural population
• Spirometry + Symptom & Medication Questionnaire
• Uptake: 94%
• Mean age 63.7 yrs
• Airways obstruction in 27.5%
• COPD in 8.9% (mild 27%, moderate 64%,
severe 9%)
• No recorded diagnosis in 64%
Seamark DA, et al. PCRJ 2001;10:30-33.
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