Investigating current practice of prescribing ‘rescue packs’ in COPD in primary care in England

Background Chronic obstructive pulmonary disease (COPD) refers to a group of conditions which cause breathing difficulties, affecting estimated 3 million people in the UK. Without optimal treatment, the symptoms usually get progressively worse, often causing acute exacerbations (AECOPD).

According to the national guideline, all patients at risk of AECOPD should have individualised exacerbation action plans.

They often provide people with short courses of antibiotics and oral corticosteroids, called 'rescue packs' to use at home when needed.

Ideally, these should be appropriately documented, prescribed as an acute (not repeat) prescription and accompanied by comprehensive patient education on how to use them.

Little evidence exists about whether these recommendations are routinely met. 'Rescue pack' prescriptions are often poorly documented.

As a result, many exacerbations go unnoticed which leads to missed opportunities to offer patients key interventions (smoking cessation, vaccinations, pulmonary rehabilitation and medicines optimisation). These interventions can reduce and delay further exacerbations, and improve patients' health.

Aims To assess the prevalence and variations of COPD 'rescue pack' prescriptions in primary care in England To understand patient-reported experience of 'rescue pack' provision To determine GPs' knowledge of and attitudes towards the national recommendations for 'rescue pack' prescribing Methods Workstream 1: To determine the prevalence and variations of 'rescue packs' issued in primary care in England by analysing: detailed patient health records from a representative selection of general practices in England, in a retrospective database cross-sectional study large-scale healthcare datasets.

Workstream 2: To assess patients' confidence in using 'rescue packs' and perceptions of the quality of education received from GPs, using a mixed method approach: focus groups survey Workstream 3: To assess the GPs' awareness of the national guideline for 'rescue packs' prescribing and evidence of it being followed, using a mixed method approach: survey interviews Timelines The set up and implementation of workstreams will overlap and take approximately 12 months for each.

The last six months of this project will be spent on writing up the thesis. Detailed timelines are presented in the attached Gantt chart.

Impact This will be the first study investigating COPD 'rescue packs' prevalence and variation in primary care in England.

It will also be the first to determine prescribers' adherence to the relevant national recommendations and patients' experience of the 'rescue packs' provision. Mapping out the current practice will help to inform quality improvement projects, guidelines and future research.

I anticipate that this research will lead to significant improvements in AECOPD management, achieved through increased guideline adherence and awareness of the importance of early intervention.

This would lead to better symptoms management, reduced frequency of exacerbations and therefore reliance on emergency healthcare, and enhanced patient quality of life.

Dissemination A plain scientific summary of this project will be shared with patients through the Breathe Easy groups communication channels.

Educational webinars and workshops built on this research findings will be provided to healthcare professionals and patients.

Publications from each workstream will be presented at the conferences and workshops and submitted to peer-reviewed national and international journals.