Patient Empowerment in Patient Empowerment in Chronic Obstructive Chronic Obstructive

Pulmonary Disease (COPD)Pulmonary Disease (COPD)

Noreen Baxter

Respiratory Nurse Specialist

May 2005

Definition of COPDDefinition of COPD

Chronic obstructive pulmonary disease (COPD) is characterised by airflow obstruction. The airflow obstruction is usually progressive, not fully reversible and does not change markedly over several months. The disease is predominantly caused by smoking (NICE 2004)

COPD produces symptoms, disability and impaired quality of life.

Epidemiology of COPDEpidemiology of COPD

• 1% of the UK population is diagnosed with COPD

• 50% of presenting patients are correctly diagnosed

25% of the total number of COPD patients are recognised

• The potential prevalence of COPD in the UK is estimated to be approximately 3 million

Global ImpactGlobal Impact

Only preventable cause of death currently increasing

COPD is currently the 4th leading cause of death

By 2020 expected to rank 5th as a world wide burden of disease

Local ImpactLocal Impact

50 practices in North and West Belfast 6 practices involved in the projectTotal number of patients-19,524 patientsPatients on the COPD register-598 patients75% of patients not diagnosed

AimsAims

To initiate change in practice using evidence based guidelines and protocols

Implement a well researched and planned pilot study Provide a seamless carepathway between primary

and secondary care from diagnosis to palliation Provide greater patient choice and individualised

expert care in the patients home Increase patient satisfaction Provide an efficient and effective patient focused

service

Gaps in Services in Gaps in Services in Community and Primary CareCommunity and Primary Care

Publics lack of awareness of COPD Lack of early screening resulting in lack of health

promotion and prevention Detection of early stages ignored COPD clinics- fragmented care Treatment and follow-up not standardised Seamless care needed addressed No support for staff Slow access to specialist clinics

Gaps in Secondary CareGaps in Secondary Care

Lack of support for patients / carer on discharge No formal structured education in primary care,

community care and secondary care Lack of understanding in the importance of self

management advice Importance of referrals for holistic management

and home support were not recognised Palliative care needs were not addressed Patients choice and autonomy were ignored

Action in Primary CareAction in Primary Care

Training needs were identified Multiprofessional study days /educational sessions held Health screening for early diagnosis / prevention (30% of

patients with COPD) Facilitation at COPD clinics, smoke cessation clinics, health

promotion awareness sessions Evidence based standardised care / follow-up Initiate optimal treatment / seamless care Self management strategies

Action in Secondary CareAction in Secondary CareIntensive Home SupportIntensive Home Support

Follow up for those with severe disease / NIV

Patients commenced on Long Term OxygenNon attendees at clinicsRegular attendees at A/EFollow up for those discharged from A/EHousebound patients referred by GP for

management and optimal treatment

Education PackageEducation Package

Disease / Symptom and anxiety management Exacerbation management Self management plan Smoking cessation /energy conservation/breathing

techniques / nutritional advice / exercise/relaxation Goal setting /appropriate MDT referrals Advice on LTOT/nebuliser /inhalers Sexuality / travel/ benefits Advanced directives. Palliative care issues addressed Contact number

OutcomesOutcomes

69 patients involved32% were not readmitted9% had fewer admissions41% reduction in readmissions (despite

being at the severe end of the disease)40% of patients had been treated at home

for exacerbations

Benefits for the patientBenefits for the patient

Raise self esteem/self worth/ self control Patients are listened to as experts of their own

disease initiating individualised care Empowerment,quality, choice and autonomy Provide a holistic approach to patient care Patient / carer satisfaction Palliative end stage care and support Anxiety and depression are identified and addressed Improved compliance with treatment

Benefits for the serviceBenefits for the service

Raise awareness Health screening, health promotion /prevention Early diagnosis Improved communication and documentation between

secondary and primary care Seamless approach to care. Evidence based with local

protocols. Patients expertise are used in education Reduced admission rates Improved access to specialist clinics

Moving OnMoving On

Early Supported Discharge Scheme Community based Respiratory Nurse Specialists Intensive home support to continue Specialist Physiotherapist/Occupational

therapist/Dietician/Social worker/Psychologist Medical staff grade working across the interface Respiratory teams working in collaboration Joint working between Trusts/Primary care and

community