Improving the diagnosis of breathlessness in primary care: Large scale implementation of the “Breathlessness Diagnostics in a Box” (BiaB)

Research question: What is the effect of implementing BiaB in primary care on the number of newly diagnosed patients with COPD and/or heart failure (HF) and time to diagnosis? Background: Breathlessness is a common reason for consulting a general practitioner (GP) and can have different causes including pulmonary, cardiovascular, and psychological factors. There is a lack of easy-to-perform tests in primary care to diagnose the cause of breathlessness. BiaB is a quick and easy tool which offers reliable support to GPs in diagnosing the cause of breathlessness. In this study, we will evaluate the effect of implementing BiaB on a large scale. Methodology: The BiaB box will be improved and updated based on the results of the pilot study performed in Dutch primary care. An (international) platform protocol for primary care will be written to evaluate the BiaB on a large scale. A stepped wedge trial will be conducted in at least 3 countries with 15 GP practices and 300 patients per country, to be able to assess effectiveness of the health care improvement process. The effect on individual patients and care processes will be evaluated in a prospective way. Every 2 months a data dump from the GP record system will be requested to evaluate the number of COPD and/or HF diagnosis and to assess the effects on (proxy) outcomes of breathlessness. Study population: Patients with breathlessness of unknown cause or at risk of HF or COPD. Study outcomes: (New) working diagnoses, time between consultation, number of times BiaB is used and spirometry and ECG performed, number of referrals and hospital admissions, budget impact analysis. Sponsor grant: Study supported by AstraZeneca. Questions to discuss: - For which other indications/symptoms would the box be useful? - Are there more outcomes of interest?