Feasibility and efficacy of COPD case finding by practice nurses.
BACKGROUND
Chronic obstructive pulmonary disease (COPD) is a leading cause of disability, hospital admission and premature mortality, but is often undiagnosed. This study assessed the effectiveness, feasibility and acceptability of COPD case finding by practice nurses performing spirometry on patients identified as being at risk of developing COPD.


METHODS
Practice nurses were trained in spirometry. From four general practices, 1010 patients were identified who were aged 40-80 years and current or ex-smokers. Four hundred were randomised to receive a written invitation to attend a case finding appointment with the practice nurse, including spirometry.


RESULTS
Seventy-nine patients attended, 16 (20.3% of attendees) had COPD diagnosed on spirometry; practice nurses correctly identified 10 of the 16, but also incorrectly identified a further six patients as having COPD. One patient in the usual care group was diagnosed with COPD, but this was not confirmed on spirometry.


CONCLUSIONS
This study confirmed that COPD is underdiagnosed, with 20% of those at risk and attending for screening having COPD. The search strategy successfully identified patients at risk. Further training in spirometry would be required for practice nurses to increase the accuracy of the diagnoses. The opportunity cost would require consideration. The acceptability to patients is also an issue, this may be related to the recruitment method or the intervention. This study also does not answer whether earlier diagnosis in these patients leads to any change in outcomes.
Bunker
Jeremy
J
South West Area Health Service, and Conjoint Lecturer, School of Public Health and Community Medicine, University of New South Wales. jeremyb@sigpet.com.au
Hermiz
Oshana
O
Zwar
Nicholas
N
Dennis
Sarah M
SM
Vagholkar
Sanjyot
S
Crockett
Alan
A
Marks
Guy
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D005194:Family Practice; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000451:nursing*; D008875:Middle Aged; D015999:Multivariate Analysis; D009517:New South Wales; D009740:Nursing Staff / Q000193:education; D029424:Pulmonary Disease, Chronic Obstructive / Q000209:etiology / Q000517:prevention & control*; D018570:Risk Assessment; D013147:Spirometry / Q000451:nursing*