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

2

Underdiagnosis of COPD

Nacul et al. J Pub Health 2010

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

www.rightcare.nhs.uk/index.php/atlas/respiratorydisease/

Atlas of Variation In Respiratory Healthcare

3

Depending on where I live I am 3 times more likely to get my COPD diagnosed

www.inhale.nhs.uk/

inhale Database

4

APHO Data on General Practice

http://www.apho.org.uk/PracProf/

5

Extent of Underdiagnosis in England

93.6 78.7

53.2

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20

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40

50

60

70

80

90

100

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Shahab et al. Thorax 2006;61:1043–1047

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%.

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

7

Raising Awareness

Raising Awareness

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

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

• 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%

• Random sample of 100 patients attending surgery

• Age 45+

• Mixed urban/rural population

• Spirometry + Symptom & Medication Questionnaire

• Uptake: 94%

Seamark DA, et al. PCRJ 2001;10:30-33.