Between-practice variation in chronic obstructive pulmonary disease diagnosis guideline compliance: an observational...

Area of Science:

• Primary Care Research
• Respiratory Medicine
• Health Services Research

Background:

• Early diagnosis of chronic obstructive pulmonary disease (COPD) is essential for effective management.
• Current adherence to diagnostic guidelines and variations in primary care practices remain unclear.

Purpose of the Study:

• To assess adherence to diagnostic guidelines for COPD in primary care.
• To quantify variations in guideline compliance among general practitioner (GP) practices.
• To analyze changes in guideline compliance over time, including the impact of the COVID-19 era.

Main Methods:

• An observational study utilizing the Clinical Practice Research Datalink in English primary care.
• Analysis of pre-diagnostic investigations (spirometry, chest X-ray, FBC, BMI) for COPD patients across three time periods (2006-7, 2016-7, 2020).
• Multilevel logistic regression and funnel plots were used to quantify practice-level variations in spirometry use.

Main Results:

• Spirometry use increased from 62.8% in 2006-7 to 74.2% in 2016-7, but declined to 61.1% in 2020.
• Use of chest X-ray, FBC, and BMI improved and was maintained across cohorts, with nearly all patients receiving at least one.
• The proportion of patients receiving all four investigations before diagnosis rose from 26.6% to 46.7% between the first two cohorts.

Conclusions:

• Significant, non-random variations in spirometry use exist between GP practices.
• While use of chest X-ray, FBC, and BMI has improved, spirometry recording requires further consistent enhancement.