Clinic audit on Chronic Obstructive Pulmonary Disease (COPD) management in public primary care setting: Hong Kong experience

Background Chronic obstructive pulmonary disease (COPD) is a common condition encountered in primary care and presents a substantial burden to the health care system. This study aimed to audit COPD care at all public primary care clinics of Hong Kong and to work out improvement strategies. Method The computer record of COPD patients aged 40 or above and had been followed up at any of the 73 public primary care clinics under the Hospital Authority of Hong Kong (HAHK) were reviewed. Evidence-based audit criteria and performance standards were established after thorough literature review. In the first phase from 1st April 2017 to 31st March 2018, deficiencies of care were identified. It was followed by a one-year implementation phase through which a series of improvement strategies were executed. Outcome of the service enhancement was assessed in the second phase from 1st April 2019 to 31st March 2020. Student’s t test and Chi-square test were used to identify any statistically significant changes between the two. Results Totally 10,385 COPD cases were identified in Phase 1, among whom 3,102 (29.9%) were active smokers. Most of the patients were male (87.7%) and the mean age was 75.3±9.9 years old. Of those smokers, 1,788 (57.6%) had been referred to Smoking Counselling and Cessation Service (SCCS) and 1,578 (50.9%) actually attended it. 4,866 cases (46.9%) received Seasonal Influenza Vaccine (SIV) and 4,227 cases (40.7%) received Pneumococcal Vaccine (PCV). 1,983 patients (19.1%) had spirometry done before and 1,327 patients (12.8%) had been admitted to hospital due to acute exacerbation of COPD (AECOPD). With the concerted effort taken during the implementation phase, Phase 2 data showed a significant improvement in all criteria. There was a marked increase in the SIV and PCV uptake rate, spirometry performance rate and most importantly, a significant reduction in AECOPD rate leading to hospital admission (9.6%, P<0.00001). Conclusion COPD care at all public primary care clinics of HAHK had been significantly improved for all audit criteria via the systematic team approach, which in turn reduced the hospital admission rate and helped relieve the burden of the healthcare system. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement All authors have completed the Unified Competing Interest form and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work. This project was not funded by any agency in the public, commercial, or not-for-profit sectors. All authors have declared no conflicts of interest. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: No ethical approval is needed in view of audit nature of the study. This complies with local ethics committee from the Hospital Authority of Hong Kong that no formal ethical approval was required for clinical audit. All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The datasets used in the current study were compiled by the Statistical Team from the Head Office of HAHK and are used as internal reference only. They would be available from the corresponding author on reasonable request after being approved by Head Office of HAHK. * AECOPD : Acute Exacerbation of Chronic Obstructive Pulmonary Decease CAT : COPD Assessment Test CDARS : Clinical Data Analysis and Reporting System CMS : Clinical Management System COPD : Chronic Obstructive Pulmonary Disease FU : Follow Up GOLD guideline : Global Initiative for Obstructive Lung Disease guideline GOPCs : General Outpatient Clinics HAHK : Hospital Authority of Hong Kong HK : Hong Kong LAMA : Long Acting Anti-muscarinic Antagonist mMRC : Modified Medical Research Council PCV : Pneumococcal Vaccine QA subcommittee of COC (FM) : Quality Assurance subcommittee of the Coordination Committee of Family Medicine SCCS : Smoking Counselling and Cessation Service SIV : Seasonal Influenza Vaccine SOPCs : Specialist Outpatient Clinics