Wales primary care clinical audit report 2021

The audit builds upon the learning from the 2020 report. 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.

This report presents results from an analysis of asthma and chronic obstructive pulmonary disease (COPD) primary care data in Wales from the third round of the Welsh primary care audit component of the National Asthma and COPD Audit Programme (NACAP). Data were supplied by 314 (80.7%) general practices in Wales in October 2021 to capture a activity up to 31 July 2021.

Key recommendations

Primary care practices in Wales should:

1. Record quality assured post-bronchodilator spirometry ratio <0.7 for people on the COPD register by April 2023. Ensure they have an accurate record in their notes, including a spirometry trace, correct ratio and appropriate SNOMED code. 

    

   National target for Wales: 40% or more of people on the COPD register

2. Evidence and code* appropriately objective variability for people diagnosed with asthma as demonstrated by at least one of the following by April 2023:

    

   National target for Wales: 80% or more of people with asthma

   • Spirometric evidence of a significant FEV1 response to a short-acting beta-2 agonist (SABA) or after a trial of treatment with inhaled corticosteroids (ICS) (increase of 12% or more + 200mL response to beta-2 agonist or 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) (>20% variability after ≥twice daily for 2-4 weeks)
   • Positive fractional exhaled nitric oxide (FeNO) result. 
         
3. Ask parents about second-hand smoke exposure and provide very brief advice (VBA) at their child’s asthma review. Evidence with the appropriate SNOMED code* in the child’s notes by April 2023.

    

   National target for Wales: 20% or more of parents who have children and/or young people with asthma

4. Refer people with COPD and a Medical Research Council (MRC) breathlessness score 3–5 to pulmonary rehabilitation (PR) and evidence this with the appropriate SNOMED code*  in their notes by April 2023.

    

   National target for Wales: 70% or more of people with COPD

5. Provide people with asthma with a personalised asthma action plan (PAAP) and evidence this with the appropriate SNOMED code*  in their notes by April 2023.

    

   National target for Wales: 50% or more of people with asthma

6. Evidence an inhaler technique check in the last year for people with asthma and/or COPD with the appropriate SNOMED code* in their notes by April 2023.

    

   National target for Wales: 70% or more of people with asthma and/or COPD

How to use this report

This report comes in two parts:

1. Wales primary care clinical audit report 2021 - this presents key findings and recommended improvement priorities.
2. Wales primary care audit data analysis and methodology report 2021 - this contains the full data analyses from which the key findings and improvement 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.

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Local Health Board (LHB) reports