David Price, John R Hurst, Margee Kerr, Katherine Hickman, Mukesh Singh, Michael G Crooks, Luis A. Alves, Cono Ariti, Mona Bafadhel, Mohit Bhutani, John Busby, Victoria Carter, James D. Chalmers, Rongchang Chen, Amy Couper, Graham Devereux, Neva Eleangovan, Alexander Evans, Daryl Freeman, Chris P. Gale, Martin Gibson, David M.G. Halpin, William Henley, Jonathan Marshall, Fernando Martinez, Marc Miravitlles, Tamsin Morris, Hana Muellerova, Shigeo Muro, Jonatan Nåtman, Rachel Pullen, Jennifer K. Quint, Anita Sharma, Dave Singh, Derek Skinner, Daiana Stolz, Della Vargese, Elango Vijaykumar, Tonya Winders, Tom Wilkinson, Andrew P. Dickens
Introduction
Patients with COPD are at high risk of exacerbations. The PREVAIL trial1 investigated the CONQUEST2 quality improvement programme (QIP) in patients with newly diagnosed (ND) and already diagnosed (AD) modifiable high-risk (MHR) COPD.
Aim
To compare COPD exacerbations between CONQUEST patients and usual care.
Methods
English general practices were randomised 1:1 to CONQUEST (intervention) or usual care (control). MHR eligibility: 40-80 years, COPD diagnosis or positive smoking history, dual COPD maintenance therapy or less, ≥2 moderate or ≥1 severe exacerbation in prior 24 months (≥1 in last 12 months). ND patients were identified by CONQUEST spirometry or usual care. CONQUEST provided case-finding, clinical review for assessment and treatment optimisation, and follow-up (Fig.1). Exacerbations with subsequent hospitalisation/OCS/antibiotics 8-28 days after initial treatment were defined as complicated. Electronic health records were analysed using propensity score weighted models.
Results
85 intervention and 90 control practices contributed 5,631 patients (mean follow-up: 24 months). Exacerbations and complicated exacerbations reduced by 13% and 26% compared to controls, 21% and 45% in those on monotherapy or less at baseline and 21% and 40% in ND patients (Fig.1).
Conclusion
The CONQUEST QIP reduced COPD exacerbations in primary care MHR patients, especially those on minimal therapy or newly diagnosed; supporting prompt clinical review and treatment optimisation of at-risk patients.