Improving the diagnosis of breathlessness in primary care: development and implementation of the “Breathlessness diagnostics in a Box” (BiaB).

Research Question: 1. What is the impact of using the BiaB tool in primary care on the number of new diagnoses of COPD and/or heart failure and on the time from first presentation to diagnosis? (quantitative) 2. What are the perceptions/experiences of healthcare providers and patients with using BiaB in primary care practice? (qualitative) Background: Breathlessness is a common reason for consulting a general practitioner 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. In this pilot study, we design and test BiaB, an easy and quick tool which aims to offer reliable support to general practitioners in diagnosing the cause of breathlessness. Possible methodology: Healthcare professionals and clinical experts in the fields of pulmonology, cardiology and general practice co-designed the tool. The current version of the box (Figure 1) includes an oscillometer; a 4-patch, 12-lead ECG; a point-of-care NT-proBNP test, a pulse oximetry meter and a tablet with an app that integrates all measurements into a recommended working diagnosis. A pilot implementation study will be performed in six primary care practices, over a six-month period. The proposed tool will be adapted and optimised through regular meetings and interviews with healthcare professionals and patients from participating practices in an iterative manner. Study population: patients with breathlessness of unknown cause or at risk of HF or COPD. Study outcomes: (new) working diagnoses, number of referrals and confirmed diagnoses, time between consultation, diagnosis and therapy initiation and number of new diagnoses of COPD, HF and their overlap. Sponsor grant: study supported by AstraZeneca. Questions to discuss: -Methodology; additional tools needed for the box? -Data collection; other necessary variables to collect? -Study population; potential patient groups to include in study?