National audit recommends intersectoral communication and education to improve COPD care

Juliana Holzhauer-Barrie, COPD Audit Programme, Royal College of Physicians

In 2017, the National COPD (Chronic Obstructive Pulmonary Disease) Audit Programme extracted Read coded data from 407 (94%) of all Welsh general practices, including the records of 82,696 patients. A national report, seven local health board reports (including cluster level results), and a quality improvement focused slide set were all published online in December 2017. Welsh general practices are also able to see their own results on the NHS Wales Informatics Service Primary Care Information Portal.

This audit focused on queries that directly related to opportunities for improving quality of care. This included: demographics and comorbidities, diagnosis, assessing severity and future risk, and the provision of high value care. The last section focused on equity and parity between: those with and without severe mental illness, current smokers and non-smokers, as well as socioeconomic deprivation.


The audit found that only 11.1% of patients diagnosed within the last two years had a record of the gold standard diagnostic test (post bronchodilator spirometry, with the Read code of 339m). Nearly a quarter of the 11.1% had a result that was inconsistent with COPD.

Severity and future risk

Almost 40% of audited patients did not have an MRC score recorded in the last year. Over a quarter (26.4%) were self-reported as current smokers.

Provision of high value care

It was discovered that 46.9% of patients who were prescribed an inhaler had an inhaler technique check in the last year. 34.0% of patients had not received a flu vaccination in the preceding winter (1 August 2016 to 31 March 2017). Of the current smokers in the audit cohort, 12.5% had a record of having been referred to a behavioural change intervention and had been prescribed smoking cessation pharmacotherapy. In addition, only half (50.2%) of patients with an MRC score of 3 to 5 (the patients with more pronounced COPD) had been referred to pulmonary rehabilitation (PR) within the last 3 years.

Equity and parity

Lastly, the audit found that people with severe mental illness were less likely to have their MRC score recorded, receive a flu vaccination, or be referred to PR in the last 3 years for an MRC score of 3-5. Those patients who are current smokers were less likely to have received a flu vaccination or be referred for PR in the last 3 years with any MRC score. And the 10% most deprived patients (relative to the 50% least deprived) were also less likely to have an MRC score recorded or receive a flu vaccination.


The audit report contains recommendations for primary care teams, patients with COPD, as well as respiratory specialists and system managers. A system of integrated care, ensuring that communication between the sectors and persons is open, and that staff are trained appropriately for the job they are being asked to do, is included as a key recommendation.

Read the full details in the Primary care audit (Wales) 2015–17: Planning for every breath report

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