Impact of a community respiratory assessment service on evidence based prescribing in primary care

Introduction: The Community Respiratory Assessment Unit (CRAU) in Hammersmith and Fulham provides open-access nurse-led spirometry and evidence-based disease management support to primary care.

Methods: The primary care records of 100 patients referred from March 2008 to April 2009 (51M/49F, mean age 61 years, 77 current/ex-smokers) were examined to quantify whether suggestions made in the CRAU had been translated into practice.

Results: In 32 patients no treatment change was recommended as they were already on optimal management (18 mild COPD, 8 moderate COPD, 1 severe COPD and 5 with asthma). No therapeutic changes were recommended in a further 10 with a restrictive defect and in 21 with normal spirometry. Of the 37 patients in whom a change in treatment was suggested, 29 (78%) had COPD (16M/13F, mean age 71 years, 21 current smokers, 17 mild, 8 moderate, 4 severe disease), 7 had asthma (4M/3F, mean age 39.7 years, 3 current smokers) and 1 had normal spirometry. The referring GP adopted suggested changes fully in 18 patients (49%) and partially in 5 (13%). In 14 patients (38%) the recommended alterations were not made. The range of suggested alterations of pharmacotherapy and rates of implementation in primary care are shown in table 1. In 6/18 (30%) cases where inhaled corticosteroids (ICS) or a combination of a long-acting ß agonist with ICS were recommended, this was not adopted. In 8/14 (57%) cases where tiotropium was recommended, this was not adopted.