| アブストラクト | BACKGROUND: Early chronic obstructive pulmonary disease (COPD) diagnosis is vital, but little is known about compliance with relevant diagnostic guidelines or variation in primary care. AIM: To quantify between-practice variations in guideline compliance and over time. DESIGN & SETTING: An observational study in English primary care. METHOD: The Clinical Practice Research Datalink was used to assess the use of four pre-diagnostic investigations (spirometry, chest X-ray, full blood count [FBC], and body mass index [BMI]) by GP practices for patients with COPD recorded first in primary care, in three time periods: 2006-2007 (cohort 1), 2016-2017 (cohort 2), and March-August 2020 (cohort 3). Multilevel logistic regression models quantified the non-random variation between GP practices in spirometry around diagnosis. Funnel plots counted the proportion of outliers. RESULTS: Cohort totals were 31 676 (cohort 1), 37 393 (cohort 2), and 3368 (cohort 3). Overall, the mean age was 68.3 years (standard deviation 12.0), with 46.1% female. The use of pre-diagnosis spirometry improved a little in cohort 2 (74.2%) on cohort 1 (62.8%) but fell back for the COVID-19-era group (61.1%). In contrast, chest X-ray, FBC, and BMI all improved after cohort 1 and were maintained for the COVID-19 cohort; almost all patients received one of these investigations. The proportion receiving all four investigations before diagnosis jumped from 26.6% in cohort 1 to 46.7% in cohort 2 and was maintained in cohort 3 (43.0%). Modelling and funnel plots showed considerable non-random variation in spirometry use by practice, although with some improvement since cohort 1. CONCLUSION: The recording of spirometry and chest X-rays warrants further and consistent improvement in the context of COPD care. |
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