COPD Report 5 Coles Lane, Oakington, Cambridge, CB24 3BA

COPD Patient: COPD QOF diagnosis code Practice Overview COPD Patient: COPD QOF diagnosis code Page 1

Contents Patient Demographics COPD Diagnosis COPD Health Status Risk and Exacerbations COPD Management & Reviews Recommendations Page 2

Age Distribution Co-morbidities Smoking Status Patient Demographics Contents Patient Demographics Age Distribution Co-morbidities Smoking Status COPD Diagnosis COPD Health Status Risk and Exacerbations COPD Management & Reviews Recommendations Page 3

Patient Demographics Age Distribution Page 4

Co-morbidities Patient Demographics Page 5 Rhinitis: Read code entry in last 2 years or nasal steroid therapy in last year GERD, Depression/Anxiety: Read code entry in last 2 years Page 5

Smoking Status Patient Demographics Page 6 Smoking status is obtained from patient questionnaires where available or from routine practice data Page 6

Confirming Diagnosis COPD Severity Status Patient Demographics Contents Patient Demographics COPD Diagnosis Confirming Diagnosis COPD Severity Status COPD Health Status Risk and Exacerbations COPD Management & Reviews Recommendations Page 7

Confirming COPD Diagnosis* COPD Diagnosis: COPD QOF diagnosis code Page 8

COPD Severity Classification* COPD Diagnosis COPD Severity Classification* Adapted from NICE and Global initiative for chronic Obstructive Lung Disease (GOLD) guidelines Page 9

COPD Severity in Patients with Confirmed Diagnosis* COPD Diagnosis COPD Severity in Patients with Confirmed Diagnosis* Confirmed COPD diagnosis: where FEV1/FVC < 0.7 Page 10

MRC Breathlessness Score COPD Assessment Test (CAT) Score Contents Patient Demographics COPD Diagnosis COPD Health Status MRC Breathlessness Score COPD Assessment Test (CAT) Score GOLD Combined Assessment of COPD Risk and Exacerbations COPD Management and Reviews Recommendations Page 11

Measuring COPD Health Status Information from practice recorded data and patient questionnaire responses is used to assess the health status of patients with COPD in three ways: The Medical Research Council (MRC) breathlessness score COPD Assessment Test (CAT) score Combined assessment of COPD using GOLD patient groups* Global initiative for chronic Obstructive Lung Disease (GOLD) patient groups can be calculated from MRC or CAT scores, reliever use and lung function data Page 12

MRC Breathlessness Scale COPD Health Status MRC Breathlessness Scale Page 13

MRC Score* Distribution COPD Health Status MRC Score* Distribution MRC data is obtained from patient questionnaires where available or from routine practice data Page 14

MRC Score* and COPD Severity COPD Health Status MRC Score* and COPD Severity OPC Service MRC data is obtained from patient questionnaires where available or from routine practice data Page 15

COPD Assessment Test (CAT) COPD Health Status COPD Assessment Test (CAT) 1 2 3 4 5 I never cough I cough all the time I have no phlegm (mucus) in my chest at all My chest is full of phlegm (mucus) My chest does not feel tight at all My chest feels very tight When I walk up a hill or one flight of stairs I am not breathless When I walk up a hill or one flight of stairs I am very breathless I am not limited doing any activities at home I am very limited doing any activities at home I am confident leaving my home despite my lung condition I am not at all confident leaving my home despite my lung condition I sleep soundly I don’t sleep soundly because of my lung condition I have lots of energy I have no energy at all Page 16

Application of CAT Score COPD Health Status Application of CAT Score Page 17

CAT Score* Distribution COPD Health Status CAT Score* Distribution CAT data is obtained from patient questionnaires where available or from routine practice data Page 18

GOLD Combined Assessment of COPD* COPD Health Status GOLD Combined Assessment of COPD* The combined assessment of COPD aims to determine severity of disease, its impact on patients’ health status, and risk of future adverse events (exacerbations, hospitalisations, etc.) It provides a rubric for combining the key assessments of COPD to improve management of patients by categorizing them into the GOLD patients groups A, B, C or D. The key assessments include: severity of airflow limitation, symptoms and exacerbations. When assessing risk, choose the highest risk according to airflow limitation or exacerbation history (one or more hospitalisations for exacerbations is considered high risk). Adapted from Global initiative for chronic Obstructive Lung Disease (GOLD) guidelines 2014 Page 19

GOLD Combined Assessment of COPD* COPD Health Status GOLD Combined Assessment of COPD* GOLD Patient Groups RISK Airflow Limitation RISK FEV1% Predicted < 50% C D Exacerbation History ≥ 2 or ≥ 1 with hospitalisation FEV1% Predicted ≥ 50% A B 1 without hospitalisation CAT <10 or mMRC 0 – 1 CAT ≥10 or mMRC ≥ 2 SYMPTOMS or BREATHLESSNESS Adapted from Global initiative for chronic Obstructive Lung Disease (GOLD) guidelines 2014 Page 20

GOLD Combined Assessment of COPD COPD Health Status GOLD Combined Assessment of COPD Page 21

Future Risk – DOSE Score Contents Patient Demographics COPD Diagnosis COPD Health Status Risk and Exacerbations Exacerbations Future Risk – DOSE Score COPD Management and Reviews Recommendations Page 22

Exacerbations* Risk and Exacerbations Page 23 Exacerbations: exacerbation Read code entry or patient reported exacerbation & hospitalisations & number of courses of oral steroids in last 12 months Page 23

Exacerbations and COPD Severity Risk and Exacerbations Exacerbations and COPD Severity OPC Service Page 24

Future Risk: DOSE Score Risk and Exacerbations Future Risk: DOSE Score DOSE Score = Sum of Points scored for each DOSE item Validated research demonstrates that DOSE Score ≥ 4 is indicative of increased future risk of exacerbation, hospitalisation and mortality Page 25

Future Risk: DOSE Score Distribution Risk and Exacerbations Future Risk: DOSE Score Distribution Page 26

DOSE Score and COPD Severity Risk and Exacerbations DOSE Score and COPD Severity OPC Service Page 27

Pharmacotherapy Management COPD Reviews Contents Patient Demographics COPD Diagnosis COPD Health Status Risk and Exacerbations COPD Management & Reviews Smoking Pharmacotherapy Management COPD Reviews Recommendations Page 28

Smoking Status and COPD Severity COPD Management & Reviews Smoking Status and COPD Severity OPC Service Page 29

Pharmacotherapy Management: NICE Guidelines 2010 COPD Management & Reviews Pharmacotherapy Management: NICE Guidelines 2010 Page 30

Pharmacotherapy Management COPD Management & Reviews Pharmacotherapy Management Page 31

Pharmacotherapy Management by COPD Severity: COPD Management Pharmacotherapy Management by COPD Severity: All patients Page 32

Pharmacotherapy Management by MRC Score: COPD Management & Reviews Pharmacotherapy Management by MRC Score: Mild & Moderate Patients (FEV1% Predicted ≥ 50%) Page 33

Pharmacotherapy Management by MRC Score: COPD Management & Reviews Pharmacotherapy Management by MRC Score: Severe & Very Severe Patients (FEV1% Predicted < 50%) Page 34

Pharmacotherapy Management by Exacerbations: COPD Management & Reviews Pharmacotherapy Management by Exacerbations: Mild & Moderate Patients (FEV1% Predicted ≥ 50%) Page 35

Pharmacotherapy Management by Exacerbations: COPD Management & Reviews Pharmacotherapy Management by Exacerbations: Severe & Very Severe Patients (FEV1% Predicted < 50%) Page 36

COPD Reviews & Self-Management Plans* COPD Management & Reviews COPD Reviews & Self-Management Plans* COPD Reviews and Self-management plans provided in the 12 months prior to the date of extraction and recorded by Read code entry Page 37

Therapy Recommendation Management Recommendation Contents Patient Demographics COPD Diagnosis COPD Health Status Risk and Exacerbations COPD Management & Reviews Recommendations Therapy Recommendation Management Recommendation Page 38

PLEASE NOTE Recommendations The practice report recommendations have been grouped into ‘Therapy Recommendations’ and ‘Management Recommendations’. Please consider both groups of recommendations together, as a holistic approach is vital for effective patient care and optimising patient outcomes. Patients covered within each recommendation and the patient questionnaire responses can be viewed on your COPD patient level reports, through the OPC Tools application on your practice computer. Please refer to the ‘Viewing Patient Reports’ user-guide to assist you in this regard. Alternatively, please contact the OPC service delivery team for assistance. Optimum Patient Care 5 Coles Lane, Oakington, Cambridge, CB24 3BA Tel: 01223 967 855 E-mail: services@optimumpatientcare.org Page 39

Therapy Recommendations Adapted from NICE and Global initiative for chronic Obstructive Lung Disease (GOLD) guidelines Page 40

Your Practice Therapy Recommendations Page 41

Management Recommendations Adapted from NICE and Global initiative for chronic Obstructive Lung Disease (GOLD) guidelines Page 42

Management Recommendations Page 43

Your Practice Management Recommendations Page 44