Patterns of care in the management of high-risk COPD in Australia (2015-2019): an observational study for the CONQUEST quality improvement program.

Background: We compared the management of patients with 'high-risk' COPD in Australia to national/international guidelines and quality standards, including the COllaboratioN on QUality improvement initiative for achieving Excellence in STandards of COPD care (CONQUEST). Methods: Eligible patients in the Optimum Patient Care Research Database Australia were categorized as newly diagnosed (≤12 months after diagnosis), already diagnosed, or patients with potential undiagnosed COPD, in each year from 2015 to 2019. 'High-risk' patients had ≥2 COPD exacerbations/exacerbation-like events in the last 24 months. Descriptive statistics for 2019 are reported, along with annual trends. Findings: In 2019, 11.3% (2608/22,985) of eligible patients met high-risk criteria. Most newly diagnosed high-risk COPD patients (71.3%) had no recorded lung function testing within 12 months of diagnosis. 63.6% of new COPD diagnoses had no evidence of supporting spirometry or chest CT, with the remainder having recorded chest CT only. 44.3% of already diagnosed high-risk patients had no recorded inhaled maintenance therapy, although this was recorded for 11.2% of potential undiagnosed patients. Smoking cessation support and pulmonary rehabilitation were recorded for <40% and ≤2% of diagnosed COPD patients respectively. Interpretation: There is substantial opportunity to improve diagnosis, assessment and treatment of patients with COPD in Australia by identifying, reviewing and managing high-risk patients in accordance with evidence-based guidelines and CONQUEST standards. Funding: This study was conducted by Optimum Patient Care Australia Pty Ltd (OPCA) and was partially funded by OPCA and AstraZeneca Pty Ltd. No funding was received by the Observational & Pragmatic Research Institute Pte Ltd (OPRI) for its contribution.