P66 The effectiveness of a primary care respiratory diagnostic hub in inner city cosmopolitan population

Background Asthma and chronic obstructive pulmonary disease (COPD) are the most prevalent respiratory diseases, yet the lack of accessible standardised diagnostics in primary care often lead to erroneous or delayed diagnosis. In-community standardised respiratory diagnostic hubs (RDH) may improve patient access and diagnosis quality of asthma and COPD. Aim To evaluate the effectiveness of a RDH in primary care in establishing diagnosis in patients with suspected asthma and COPD. Methods A pilot multidisciplinary RDH was set up in inner city cosmopolitan Birmingham, to provide diagnostic services to the local population. Referred patients with suspected asthma, COPD had structured review inclusive of lung function and fraction exhaled nitric oxide ‘FeNO’ measurement. The interim diagnostic outcomes of this RDH are presented. Results Of 100 referred cases, 61 were for suspected asthma and 39 for suspected COPD. In the suspected asthma group, there were 12 (20%) cases on the asthma quality outcome framework ‘QOF’ register. Following RDH assessment, asthma was confirmed in 3/12(25%), excluded in 8/12 (67%), and remained suspected in 1/12 (8%), whilst in the 49/61 (80%) suspected asthma not on QOF register, asthma was confirmed in 18/49 (37%), remained suspected in 7/49 (14%) and an alternative diagnosis was established in 24/49 cases (49%). In the overall suspected asthma group, asthma was confirmed in 21/61 (34%) of cases, excluded in 32/61 (53%) and remained suspected in 8/61 (13%), demonstrating a diagnostic outcome in 53/61 (87%) cases. In suspected COPD, only 4 patients were on the COPD QOF register but the diagnosis was excluded in 3 of these cases following RDH assessment. In not-QOF registered suspected COPD, 11/35 (31%) had COPD confirmation, 22/35 (63%) had an alternative diagnosis and 2/35 (6%) remained suspected for COPD. RDH provided a diagnostic outcome in 37/39 (95%). Conclusion This pilot primary care RDH achieved a diagnostic outcome in the vast majority of referred cases, with asthma and COPD diagnoses excluded in over half of all referred cases. Additionally, asthma and COPD diagnoses were excluded in more than half of cases on the QOF register, prompting the need for applying this model of service at wider scale in the NHS.