Going the extra mile on respiratory care

1 August 2012
A primary care initiative to support patients in Buckinghamshire with chronic obstructive pulmonary disease (COPD) and other respiratory conditions has helped reduce emergency hospital admissions.
 
GP Nigel Masters and specialist respiratory nurse Catherine Tutt from Highfield surgery in High Wycombe have led the drive to improve the support provided to people with the condition and their carers. They worked to engage all of Chiltern Clinical Commissioning Group’s 35 practices in nominating clinicians to lead on COPD.
 
Masters explains: “We are very keen to prevent unnecessary admissions to hospital with patients suffering from chronic bronchitis and emphysema and are using a variety of strategies to achieve this. These include providing support for practice teams who in turn help their patients and families with COPD more effectively.”
 
“As a result, we are starting to see an effective and sustainable model of care. A respiratory doctor and nursing team is identified in each GP practice in Buckinghamshire. Each team undergoes an intensive education programme and works closely with local pharmacists to ensure the highest standard of care possible.”
 
The key clinicians in each practice ensure that the identified patients are regularly monitored, reviewed and encouraged to manage their condition themselves.
 
Tutt says: “We visited each surgery at the beginning of the project to determine their individual aims and objectives. Data on prevalence of COPD and hospital admissions helped with targeting areas with the most need.
 
“The key to providing better services for patients is ensuring GP practices learn from each other and from the best examples of care. There is great enthusiasm among clinicians and this is shown by proactive chronic disease management. That should include clear action plans, support for self-management, home provision of standby medication and referral for pulmonary rehabilitation when indicated.”
 
The beneficial impact on people’s lives is reflected in a 30% reduction in hospital admissions for people with chronic bronchitis and emphysema in three years.
 
The GPs and nurses have undertaken distance learning courses subsidised by the former Bucks Primary Care Collaborative and Masters and Tutt also have regular educational meetings which are well attended by the local GPs and nurses.
 
The two colleagues have encouraged the use of a bespoke computerised template which acts as a care pathway and aide memoire for regular review of patients.
 
All practices are now well-equipped with pulse oximeters (devices that measure oxygen levels with a simple fingertip test) and microspirometers for screening smokers over 35 years to identify undiagnosed COPD patients.
 
Masters says: “This is not in the national guidance so we are going beyond that. The other big push was to screen for cardiac disease and give statins where appropriate. This is not just about focussing on the lungs of patients with COPD but to look holistically - checking the heart and blood pressure and doing diabetes screening. If you get this right, patients are less likely to be admitted.”
 
Resources developed by the Highfield practice are available at www.copdprojectpack.co.uk
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