Finding the Missing Millions• Scale of misdiagnosis and under-diagnosis• Possible reasons for this• Opportunities for earl...
Underdiagnosis of COPD                                               The ratio of diagnosed to                            ...
Depending on where I live                  I am 3 times more likely to                  get my COPD diagnosedinhale Databa...
APHO Data on General Practice       http://www.apho.org.uk/PracProf/                                          4
Extent of Underdiagnosis in England             8215 people in Health Survey for England      Spirometry-defined COPD was ...
Finding the Missing Millions• Scale of misdiagnosis and under-diagnosis• Possible reasons for this• Opportunities for earl...
Raising AwarenessRaising Awareness                    7
Raising Awareness & Encouraging Testing        Know it. Check it. Treat it.Using a combination of centrally coordinated an...
Finding the Missing Millions• Scale of misdiagnosis and under-diagnosis• Possible reasons for this• Opportunities for earl...
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Breakout 4.1 Finding the missing millions - David Halpin

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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

Published in: Health & Medicine
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Breakout 4.1 Finding the missing millions - David Halpin

  1. 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 1
  2. 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/ 2
  3. 3. Depending on where I live I am 3 times more likely to get my COPD diagnosedinhale Database www.inhale.nhs.uk/ 3
  4. 4. APHO Data on General Practice http://www.apho.org.uk/PracProf/ 4
  5. 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 5
  6. 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 6
  7. 7. Raising AwarenessRaising Awareness 7
  8. 8. Raising Awareness & Encouraging Testing Know it. Check it. Treat it.Using a combination of centrally coordinated andlocally-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 breathlessRaising Awareness & Encouraging Testing Know it. Check it. Treat it. Salford 8
  9. 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. 9

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