'Replace spirometry quality points'

Spirometry measurements for COPD should be phased out of the quality framework and replaced by symptom measurements, say respiratory experts.

Seventeen of a possible 33 quality points awarded for care of COPD patients are for spirometry measures to diagnose and monitor the condition.

The General Practice Airways Group (GPIAG) is recommending the 2008/9 quality framework takes account of the Medical Research Council dyspnoea score every 15 months.

This approach would be a better indicator of disease severity and would help tailor treatment to individuals, said Kent GP and GPIAG member Dr Hilary Pinnock who helped compile the group’s proposal.

Spirometry is important for diagnosing COPD and distinguishing it from asthma, but its value at 15-month check-ups is less certain.

‘We’re suggesting that annual spirometry might be more often than is needed,’ she said. ‘We suggest reducing the frequency of spirometry measurements.

‘This is good clinical care as recommended by the British Thoracic Society (BTS)/SIGN guidelines and NICE.’

GPIAG recommendations on asthma and COPD are to be built into a consensus alongside the British Thoracic Society and Educators for Health, after the organisations made similar proposals to the quality framework review board.

In May, respiratory charities will meet the quality framework review board to discuss the changes. Changes are scheduled to be finalised by negotiators by November, although this looks unlikely.

‘What we’re really trying to do is to appreciate that one size doesn’t fit all,’ said Dr Pinnock.

GPIAG wants asthma reviews to be extended to include an assessment of adequate control to help tailor care to individuals.

GPs are awarded up to 45 quality points for asthma. GPIAG wants GPs to be given additional points for patients having a personal asthma management plan to boost self-management of the condition.

‘One of the other things we will be putting into the quality framework review is the link between asthma and rhinitis. We’re trying to build up a holistic picture,’ said Dr Pinnock.

‘We will be fighting hard to keep and increase our quality indicator points, and we are confident that we have well-thought-out evidence-based recommendations.’

But Dr John Haughney, Glasgow GP and president of the International Primary Care Respiratory Group, said all of the asthma indicators should be overhauled.

‘The quality indicators for asthma are weak and should be reviewed. What we have bears no resemblance to good practice for asthma care,’ he said. ‘It requires substantial revision.’

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