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Beverley Cox describes the introduction of a user-friendly assessment tool to improve the management of chronic obstructive pulmonary disease
Summary
This article discusses the development of the chronic obstructive pulmonary disease assessment tool (CAT). It explains how the CAT is more user-friendly than previous tools aimed at assessing quality of life in patients with respiratory disease and highlights how CAT may help to improve communication between health professionals and patients.
Keywords
Respiratory disease, patient assessment, quality of life, communication
chronic obstructive pulmonary disease (CO PD) costs the NHS around £800 million per year (Department of Health (DH) 2004) and incurs some of the highest costs of in-patient stays (British Lung Foundation (BLF) 2007). It is set to become the world's biggest cause of death by the year 2030 (World Health Organization 2008) and is already the third biggest cause of death in the UK (BLF 2007).
The Lost in Translation report (BLF 2006) states that the morbidity associated with CO PD is hard to define. Many patients are suboptimally treated, and may be suffering more than necessary, particularly with the psychosocial consequences of the condition (BLF 2006). There appears to be a lack of good communication between patients and professionals in identifying priorities for care. The tick-box approach of the Quality and Outcomes Framework (QOF) may lead to better data collection, but it may not necessarily give patients what they want from their consultations (BLF 2006).
Many people with CO PD underestimate their symptoms (Murray and Lopez 1997). A study by Rennard et al (2002) revealed significant disparity between patients' views of the severity of their condition and the degree of severity suggested by measuring dyspnoea.
Marno et al (2006) identified some of the issues which may lead to an increased risk of exacerbations, leading to subsequent morbidity (permanent loss of lung function) and mortality for patients with CO PD.
Patients with severe disease are at increased risk of developing depression (van Manen et al 2002). The survey by Rennard et al (2002) found that the ability of patients to take part in many daily activities was severely restricted by CO PD, independent of the patient's age.
In the general practice setting, assessment of health status should contain an element of quality of life...