A Proactive Integrated apprOach to ideNtifying and trEating people with COPD and “trEatable traits” in primary caRe (PIONEER COPD)

COPD affects around 1.2 million people in the UK and is nearly twice as prevalent in the highest socioeconomic decile compared to the lowest. Access to COPD care is not equal, with referrals to services such as pulmonary rehabilitation lower for certain groups such as those from areas of greater socioeconomic deprivation. In the UK, COPD is largely managed in primary care however, there are an increasing number of specialist interventions, such as lung volume reduction therapies or home ventilation that have been shown to improve symptoms or reduce exacerbations for people with certain 'treatable traits'. Furthermore, recent trials of biologics to reduce exacerbations of COPD have been positive and are likely to be soon approved for clinical use. Currently, specialist intervention is reactive, resulting in significant inequalities in the provision of care. A more proactive approach, in which individuals who may benefit from specialist intervention are identified from routine medical records and invited for an assessment, may help to tackle this inequality in access. This would allow specialist assessment and treatment based on clinical need rather than access to services, targeting individuals with specific therapeutic opportunities identifiable from their primary care record. Overarching Research Aims: To reduce health inequalities in access to specialist care in COPD, To develop and implement an assessment model that identifies, in a primary care setting, people with COPD and 'treatable traits' who may benefit from specialist intervention. Specific Objectives: To understand current specialist referral practices in COPD and explore potential barriers to access including the effects of socio-economic status and protected characteristics, To co-design, with input from patients and clinicians, a comprehensive assessment model for people with COPD and 'treatable traits' identified from their primary care record, To test the feasibility of conducting a clinical trial implementing this assessment model into primary care. Methods This fellowship will consist of three work packages: WP1 - mixed methods exploratory analysis using patient focus groups and a primary care database study (CPRD) to understand current healthcare usage and explore potential barriers to access for individuals with COPD and 'treatable traits'. WP2 -co-design a comprehensive assessment model for individuals with COPD and 'treatable traits' who may be eligible for specialist intervention. WP3 - A randomised controlled pilot study of the assessment model developed in WP2. A process evaluation will be conducted alongside the development and testing of the assessment model to optimise implementation of the assessment model into integrated clinical care. Timelines for delivery The proposed fellowship would run for 60 months. WP1 and 2 would run in year 1 and 2, WP3 would run in years 2-5. Impact and dissemination If the trial of the comprehensive assessment model is feasible, I would apply for further funding to assess the impact of the model in a fully powered randomised controlled trial. Results of the studies will be presented to public and patient groups, at respiratory conferences, local clinical meetings and submitted for publication in high impact respiratory journals.