Variation in patient pathways and hospital admissions for exacerbations of COPD: linking the National Asthma and COPD Audit with CPRD data Imperial College London

Most people with COPD experience episodes of worsening of respiratory symptoms; called ‘exacerbations’. COPD exacerbations are the second most common cause of emergency hospital admission in adults in the UK.

The National Asthma and COPD Audit Programme (NACAP) is a continuous audit of English hospital admissions for COPD exacerbations. It contains detailed information on clinical features associated with these admissions.

This project by Imperial College London involved linking this audit data with primary care data on COPD from CPRD.

The research found that 80% of patients who were admitted to hospital for an acute exacerbation had contact with their GP in the two weeks prior to their admission and that 86% of admissions were clinically appropriate.

Contact with primary care did not appear to have an effect on the appropriateness of an admission. 20% of patients received a prescription for a rescue pack of antibiotics and oral corticosteroids in the two weeks prior to their admission, but again this did not appear to have any impact on admission appropriateness.

Receiving a COPD discharge care bundle was associated with receipt of key items of best practice care (follow-up within two weeks, assessment for referral to pulmonary rehabilitation, referral for smoking cessation, inhaler technique check, and prescription of a rescue pack). However, the association between discharge bundles and best practice care appears to be driven by the care received in secondary rather than primary care; further exploration is needed. 

This work has improved understanding of the full patient pathway and identified variations in care to determine areas for improvement. The research team will feed this back to stakeholders and the results have impacted NACAP audits going forward.

Contact information

For more information about this project, please contact Professor Jennifer Quint, Professor of Respiratory Epidemiology, Imperial College London.