title: Early detection of COPD in general practice: implementation, workload and socioeconomic status. A mixed methods observational study.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) is underdiagnosed in general practice. Our aim was to implement a population-based approach for the early detection of COPD and to assess its impact on primary care workload and costs, and the influence of socioeconomic status (SES).
  
  
  METHODS
  An observational study with mixed methods was performed in 10 Dutch general practices of either low or moderate to high SES. The Respiratory Health Screening Questionnaire was posted during a three-month period to all persons aged 45, 55, and 65 years (one age group per month). The practices calculated the risk, and patients at high risk of COPD were invited for spirometry at the practice. The general practitioner used the spirometric results and a consultation to establish a clinical diagnosis. Qualitative and quantitative data on workload, cost, and barriers were evaluated.
  
  
  RESULTS
  Ten practices returned 293 (35.3%) COPD risk tests for the three age groups. Participants from low SES practices responded better than those from moderate to high SES practices (40.8% vs. 30.5%). In practices with low SES 17.9% of the tests indicated high risk compared with 16.1% in practices with moderate to high SES. Nine patients (23%) were newly diagnosed with COPD. The healthcare providers' extra workload averaged 18.5 hours during the three months for one standard practice. The average cost of this survey programme (three age groups in three months) was €520 for low SES practices and €398 for moderate to high SES practices. All healthcare providers affirmed that the extra workload in this survey model is acceptable and feasible when finances are compensated.
  
  
  CONCLUSIONS
  Early detection of COPD is feasible in daily life primary care. In moderate to high SES practices the costs of detecting COPD were less than in low SES practices.
authors: Caphri School of Public Health and Primary Care, Department of General Practice, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors: Joseph A M
authors: JA
authors: Dirven
authors: Huibert J
authors: HJ
authors: Tange
authors: Jean W M
authors: JW
authors: Muris
authors: Karin M A
authors: KM
authors: van Haaren
authors: Gerrit
authors: G
authors: Vink
authors: Onno C P
authors: OC
authors: van Schayck
mesh_terms: D000368:Aged; D042241:Early Diagnosis; D017048:Health Care Costs; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D011320:Primary Health Care / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis*; D012017:Referral and Consultation / Q000191:economics / Q000706:statistics & numerical data; D018570:Risk Assessment / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D012923:Social Class; D013147:Spirometry / Q000191:economics / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D016526:Workload / Q000191:economics / Q000706:statistics & numerical data*
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