Abstract
Introduction
High-dose corticosteroids have significant benefits for infective exacerbations of COPD, reducing risk of relapse, length of hospital stay and earlier symptom improvement. However, recurrent use has been shown to increase risk of comorbidities including osteoporosis, type two diabetes mellitus (T2DM), cardiovascular disease, hypertension, and elevated body mass index (BMI).
This audit assessed how many patients at Anchor Mill Medical Practice in Paisley, who had been prescribed two or more courses of prednisolone in the six months prior to the start of data collection, had been assessed for T2DM, renal impairment, elevated BMI, hypertension and osteoporosis within the previous year.
Methodology
An EMIS search was performed for patients over eighteen who were coded as having COPD and who had received two or more acute prescriptions of prednisolone from 03/04/2023 to 03/10/2023.
Data was then collected from the patient's medical summaries and investigations, looking at if they had had HbA1c, urea and electrolytes, lipids, BMI and blood pressure checked within the preceding year. The audit also looked at how many patients had had a QFracture score calculated over the past year, or if they had been referred for or had had a DXA scan within the previous five years.
Results
Over 50% had had their lipid profile and HbA1c checked, with over 75% having had their U+Es, BMI and BP checked. The major outlier was OP risk assessment, for which only 31.25% of patients had been screened.
Conclusions
Within this primary care setting, improvements could be made on screening for associated comorbidities with COPD. The patients were referred for these investigations, with the biggest improvement being a 140% increase in patients referred for a DXA scan, and annual follow up with the practice nurse was changed to include these investigations as appropriate.