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Breathlessness screening tool to aid diagnostic pathways


Morgan Liotta


21/05/2024 3:24:07 PM

The world-first tool aims to give timely diagnosis and management, while minimising the need for unnecessary tests or treatments.

Person holding chest with shortness of breath
Many people don’t raise the issue of being breathless with their GP, so the symptom is often overlooked and can present as a missed diagnosis opportunity.

A trial of a new clinical decision support tool to help doctors better identify and manage patients with breathlessness is now underway.
 
A team of general practice researchers from the University of Notre Dame has created the BREATHE SMART (Breathlessness Rapid Evaluation And THErapy – Screening, Management And IntegRated Technology) tool.
 
The program was officially launched at the RACGP’s North Sydney office on 16 May, attended by the investigator team, project collaborators, Primary Health Networks, and RACGP CEO Georgina van de Water.
 
The screening tool is linked to a questionnaire on the patients’ smartphone, with the results sent automatically to the GP through electronic medical records ahead of the appointment to determine the best diagnostic and treatment pathways for the patient.
 
Professor Charlotte Hespe is a GP, Head of General Practice and Primary Care Research at the University of Notre Dame, and immediate past Chair of RACGP NSW&ACT.
 
Earlier this year, Professor Hespe and her colleagues received a $1,178,798 Medical Research Future Fund grant for the BREATHE SMART project, to draw on their clinical expertise to develop the
world-first automated patient self-screening system for breathlessness integrated with general practice IT systems.
 
Now the trial of the project has launched, Professor Hespe said the decision-making tool will help GPs determine timely diagnosis and appropriate treatment while minimising the need for unnecessary tests or treatments.
 
‘This innovation will help GPs by using pre-consultation time to identify health issues that could otherwise go undetected and undiscussed,’ she said.
 
‘By taking the screening moment out of the GP consultation space, that time can be used more productively to diagnose the cause of the patient’s breathlessness and ultimately improve quality of life and health outcomes.’
 
According to Professor Hespe, while GPs have a central place in providing preventive healthcare they face increasing time pressures, especially in rural and remote areas where barriers to accessing care exist, and people are more likely to experience heart and lung conditions.
 
She said the study is aimed at improving GPs’ identification of people who are breathless, then improve how they diagnose and formulate a management plan – with a key target to improve outcomes for people in rural remote areas.
 
Breathlessness is a common symptom of heart and lung disease, according to the BREATHE SMART team, but can often be overlooked by patients and GPs.
 
Speaking to ABC Breakfast Radio, Professor Hespe said her team is working on the premise that ‘a huge number of people do not ever raise the issue’ of being breathless with their GP or other healthcare provider.
 
‘So then we [GPs] don’t get an opportunity to go, ‘Well, actually, it’s due to your heart not working as well as it should, or it’s definitely a lung disease”, and both of those things we can manage so the breathlessness improves considerably,’ she said.
 
‘The tool helps the GP work through what is the most likely diagnosis for breathlessness … knowing that the major causes of breathlessness are either lung disorders, heart disorders or psychological.
 
‘It takes us down the right route to then organise the right tests.’
 
Professor Hespe and her team are also aiming to ensure access pathways to the appropriate tests are improved, while making it as user-friendly as possible for patients.
 
Trialling accessibility of the questionnaire on a smartphone has been found as ‘easy to interact with’, she said, but the most significant breakthrough is the transfer of information to the GP who can then provide more advice and assistance to getting the appropriate tests ‘as quickly as needed’, particularly for those who have chronic breathlessness – symptoms for more than four weeks.
 
Since the onset of the COVID-19 pandemic, breathlessness in patients with post-COVID symptoms has increased, and although most symptoms associated with long COVID subside within a year following infection, breathlessness remains one of the most common symptoms experienced by people living with a chronic or rare lung disease or lung cancer, according to the Lung Foundation.
 
Other Australian research indicates breathlessness a common symptom in the general population and is ‘strongly associated with a significant burden of poor health’, including lower quality of life, greater health service use, and premature death.
 
With the BREATHE SMART project currently in the clinical trial phase, Professor Hespe said the team is next wanting to gauge whether patients are happy to use the system, how many use it, and how easy it is for the information to go into the GP’s records.
 
‘Then [we want to understand] how much of a difference are we actually making and diagnosing and managing breathlessness – that’s the outcome we’re interested in.
 
‘And we want to make sure it’s a program that is really easy to push into general practice so that it’s not different from what we’re already doing.
 
‘Anything that takes me more than another three to five minutes, I’m unlikely to make it my standard practice, so it’s got to be easy and really useful for everybody.’
 
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