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Wales primary care clinical audit report 2020

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This report presents results from an analysis of asthma and chronic obstructive pulmonary disease (COPD) primary care data in Wales from the second round of the Welsh primary care audit component of the National Asthma and COPD Audit Programme (NACAP). Data were extracted from 226 (56.8%) general practices in Wales in October 2020 to capture a activity up to 31 March 2020.

The audit builds upon the learning from the 2017/18 report (www.rcplondon.ac.uk/primary-care-2017-18), which was the first to report on both asthma and COPD patient care and management from primary care records in Wales. The National COPD Audit Programme previously reported on only COPD patient care and management from primary care records in Wales in 2015 and 2017. Contributing to the overarching national quality improvement (QI) objectives of the NACAP, this report aims to empower stakeholders to use audit data to facilitate improvements in the quality of care for people diagnosed with asthma and COPD.

Key recommendations

Primary care practices in Wales should:

  1. Record post-bronchodilator spirometry ratio <0.7 for 40% or more of people on the COPD register by November 2021. Ensure they have an accurate record in their notes including a spirometry trace, correct ratio and appropriate SNOMED code.
  2. Evidence and code appropriately objective variability for 80% or more of people diagnosed with asthma as demonstrated by at least one of the following by November 2021:
    • Spirometric evidence of a significant FEV1 response to a short-acting beta-agonist (SABA) or after a trial of treatment with inhaled corticosteroids (ICS)
    • Oral corticosteroids (OCS) or prescription for ICS using medication codes in conjunction with significant reversibility
    • Evidence of significantly variable peak expiratory flow rate (PEFR)
    • Positive fractional exhaled nitric oxide (FeNO) result.
  3. Ask 20% or more parents about second-hand smoke exposure and provide very brief advice (VBA) at their children's asthma review. Evidence with the appropriate SNOMED code in the child’s notes by November 2021.
  4. Refer 70% or more of people with an Medical Research Council (MRC) score 3–5 to pulmonary rehabilitation (PR) and evidence this with the appropriate SNOMED code in their notes by November 2021.
  5. Provide 50% or more of people with asthma a personalised asthma action plan (PAAP) and evidence this with the appropriate SNOMED code in their notes by November 2021.
  6. Evidence inhaler technique check in the last year for 70% or more of people with asthma and/or COPD with the appropriate SNOMED code in their notes by November 2021.

How to use this report

This report comes in two parts:

  • Wales primary care clinical audit report 2020 - this presents key findings and recommended quality improvement (QI) priorities.
  • Wales primary care audit data analysis and methodology report 2020 - this contains the full dat analyses from which the key findings and QI priorities have been derived. The data are presented largely in tabular form, with explanatory notes throughout. All appendices including the full methodology, can be found in this report.

Downloads

This presents key findings and recommended quality improvement priorities.
This contains the full data analyses from which the key findings and QI priorities have been derived. The data are presented largely in tabular form, with explanatory notes throughout. All appendices including the full methodology, can be found in this report.

Local health board reports

Quality improvement (QI) focused slides

These slides pull together the key findings of the report, with a QI focus.