Download COPD in primary care

Respiratory disease programme
for Darlington 2015-2017:
a catalyst for change.
Dr Basil Penney
Sr. Claire Adams
Darlington CCG Respiratory Leads
Respiratory disease programme for Darlington 2015-2017:
a catalyst for change.




Landscape of health care is changing rapidly
The burden of chronic disease
The pursuit of value in healthcare provision
New ways of working with other partners in
commissioning services that meet the needs of the
local population.
 Financial constraints
 Primary care will need to change
Objectives are derived from assessment of the NEQOS report
on COPD and NRAD report on asthma deaths
















Embed the concept of making every contact count in all practices and develop practice
pathways for smoking cessation
Encourage a culture of reviewing activity, sharing best practice and professional
development across practices
Commission a smoking cessation service for Darlington
Guidance/support for practices to help identify ‘missing millions’ for COPD-through
implementation of IT targeted searches and development of a diagnostic pathway in primary
care
Develop a breathlessness pathway in primary care
Develop a “quality assured “ spirometry pathway in each practice
Development of “an expert in inhaler technique” in every practice
Help to set up processes in practice for ensuring review of patients following Asthma or
COPD exacerbations
Effective template working
Tips on reviewing those with a diagnosis of COPD/asthma against the background of multiple
co-morbidity
Promotion of value based interventions eg pulmonary rehabilitation, influenza vaccination.
Identification and implementation of value –based medication changes where it is safe to do
so.
Implementation of actions for primary care set out in National Review of Asthma Deaths
Effective stepwise Asthma management (identifying possible ‘stepping down’ based on high
dose ICS)
Offer to provide general respiratory update to clinicians (GP and nurses)
Development of agreed commissioning intentions for Darlington
Barnett K et al;Lancet 2012; 380: 37–43
Why breathlessness?
 LTC agenda-demand v resources
 Co-morbidities
 Holistic v disease specific
14-18% of people with COPD only have COPD and when
actively assessed for co-morbidities it may be as low as 3%
 Breathlessness is mentioned as a reason for encounter in
primary care in about 1% of the recorded consultations in
general practice
 Primary care agenda
DIAGNOSTIC SPIROMETRY APRILJULY 2014
Practice Name
Whinfield
Orchard court
Moorlands
Neasham Road
Carmel
Blacketts
Cliffton Court
Denmark Street
Rockliffe Court
Felix House
Parkgate Surgery
34
0
13
38
36
0
0
45
6
9
3
552 Diagnostic spirometry / year-data from 8 practices
• Breathlessness Questionnaire-49 /79 response
3 case studies of breathlessness






Under use of CXR
Lack of recognition of role anxiety/depression
Understanding of Guidelines
Role of HCA
Spirometry taking up to 6 weeks(variation)
Underuse of microspirometry
CONCLUSIONS: Pre-bronchodilator microspirometry seems to be able to reliably preselect
patients for further assessment of airflow obstruction by means of regular diagnostic
spirometry. However, use of microspirometry alone would result in overestimation of
airflow obstruction and should not replace regular spirometry when diagnosing COPD in
primary care.
npj Primary Care Respiratory Medicine (2014)
24, 14033; doi:10.1038/npjpcrm.2014.33;
Further Action









Increase awareness of breathlessness
Code for breathlessness
Measure diagnostic activity- spirometry ; ECHO; BNP
New Diagnoses COPD and HF with breathlessness code
Adult Breathlessness Assessment Algorithm
Breathlessness Pathway?
Quality Assured Spirometry
GP to GP referral?
Community Clinics?
Unforseen Risk!