P239 ‘Going for GOLD’ – improving prescribing in COPD

Abstract

The increasing diversity of inhaled therapies combined with guideline differences has led to a lack of clarity regarding prescribing for COPD. This has resulted in the poor adoption of new potentially beneficial treatments, the over-prescribing of inhaled corticosteroids (ICS) and the rise in management costs. A joint working project, ‘Going for GOLD’ (G4G), was rolled out across the whole South Devon and Torbay CCG (SD and T) between 08/2016 and 02/2018. The project group consisted of two consultants and two members of the CCG Medicines Optimisation Team. The GOLD strategy provided the framework upon which the project was based. This was amalgamated with simplified prescribing to produce a one-page document that guided management in primary care. Other resources included information booklets for patients, accessible inhaler technique videos, ICS withdrawal protocol and resource packs for GP practices and pharmacists. Seven education events were held to explain the project, review the resources available, discuss cases and offer support and advice to encourage engagement. They were attended by 177 Healthcare Practitioners (HCP) following which each area was tasked with identifying patients and organising ‘G4G’ face-to-face reviews. 71.3% (4420/6200) of patients with COPD from all GP practices in SD and T participated and resulted in the following outcomes within 18 months. Compliance in prescribing rose from 26.4% to 60.3%. High-dose ICS prescribing decreased from 26.3% (53rd percentile nationally) to 16.0% (9th percentile). Unindicated ICS were reduced or stopped in 31.5% (1377) of patients. Uptake of LAMA/LABA inhalers rose from 9.4 to 130 items/month/1000 COPD patients. 125 incorrect diagnoses of COPD were identified. Net savings of £2 56 000 were generated from a £40 000 investment. This CCG-wide project brought together individuals from both primary and secondary care at a time when there was a demand for education and clear guidance regarding the optimum management of COPD. Frequently the drive has been towards the mass switching from one inhaler to another to reduce costs. G4G has delivered significant cost-savings but our ambition was to engage and educate the HCPs, provide them with the resources and support to deliver change that would result in a more sustainable improvement in local COPD care.