A pilot study of a lung health check for middle-aged adults.

“PRECURSOR” (PREdiCting YoUR patients’ riSk of Airways ObstRuction) is an online calculator that makes predictions about the chance of having a common, yet serious lung condition called chronic obstructive pulmonary disease (C-O-P-D) over the next ten years. It forms the basis of a COPD risk assessment for patients aged 40-49 years who are listed as current or past smokers in their electronic health record in the practice. All eligible people will be invited via SMS text message to receive adjunctive preventive healthcare in the form of this COPD risk assessment, similar to web-based risk calculators used to manage risk factors to prevent heart disease and diabetes. For patients aged between 40 and 49 years and not had a breathing test called spirometry to look for COPD before, they can complete PRECURSOR. In this piloting study, consented patient-participants who smoke or have smoked will be individually asked around 15 questions and some sub-questions about themselves and their health during a 20-minute phone/video interview in a single session. This will be completed together with the Project coordinator at the practice site who is a non-clinician with over 10 years’ experience of working in general practice. At the end of these questions, the calculator will provide a prediction of the participating-patients’ chance of having COPD over the next ten years. If they currently smoke, another prediction will be provided which shows the reduction in risk if they could quit smoking. Individualised feedback will be given to the participating patients by the Project coordinator, based on a pre-prepared “feedback and action” script that will be approved for use by the doctors of the pilot practice. A pdf report of the patients’ responses and their prediction will be downloaded and inserted into the patients’ electronic medical record and doctor’s inbox for further evaluation. A follow-up appointment may be arranged in pre-determined situations, at which time, the participating GP may act depending on the participating patients’ smoking status, COPD-risk prediction and/or new symptoms, if any, as they deem appropriate. Overall, the duration of the interview is expected to take between 15 to 25 minutes. Up to 30 patients will be recruited over a 4-6-week period by the Practice coordinator. Prior to GP enrolment, the Practice coordinator will attend Project Management Team meetings via zoom with pre-reading of the protocol (approx. 12 – 15 hours) and will also receive 1 – 1.5 hours of face-to-face training approx. 4 weeks and 1 week prior to the first participant enrolment. Intervention adherence by the participating GPs will be recorded by the Practice coordinator in close consultation with the Project Lead, and both will report regularly to the Principal Investigator. Intervention adherence by the participating GPs will be enhanced by group and individual training sessions, and informal discussion/s by the Practice coordinator and Project Lead with the practice manager ± GPs: 1) after the initial recruitment of 2-6 patient-participants; and 2) intermittently during the recruitment period. Participating GPs will receive reimbursements that are fitting for their time including 30-minute interviews at the end of the study. Similarly, the participating patients will be offered an honorarium for attending an one-hour focus group/interview at the end of the 4-6 month study.