Selected abstracts from the PCRS-UK National Primary Care Respiratory Conference, Telford, October 2013

Abstract

Selected abstracts from the PCRS-UK National Primary Care Respiratory Conference, Telford, October 2013 A1 PRIMARY CARE RESPIRATORY JOURNAL www.thepcrj.org http://dx.doi.org/10.4104/pcrj.2013.00105 1. Patient reported satisfaction of a proactive post hospital discharge telephone service in patients with Chronic Obstructive Pulmonary Disease Bahadur KJ, Chauhan D, McDonnell L, Osman L Physiotherapy Department, Guy’s and St. Thomas’ NHS Foundation Trust (GSTFT), London, UK Aim: Background: Although post hospital discharge telephone support (PHDTS) is a common feature of many clinical services there is little published evidence evaluating the benefits in patients admitted with an exacerbation of chronic obstructive pulmonary disease (ECOPD). Recently GSTFT introduced proactive telephone support as part of routine post-discharge care in the community for patients admitted with an ECOPD. PHDTS was provided weekly for the first month and monthly for two months thereafter. Aim: To evaluate a pro-active PHDTS service by determining patient satisfaction. Method: A patient satisfaction survey was developed with the Patient Experience Team. A convenience sample of 22 patients who received PHDTS during December 2011 was used. Patients were contacted by a single member of the Integrated Respiratory Team (IRT) and the survey completed over the telephone. Results: 21/22 (95%) patients completed the patient survey. 70% rated it “very useful” and 25% “good”. Patients reported that calls were made at convenient times, appropriate frequencies and that regular contact with staff was useful. 67% of patients thought that PHDTS helped to prevent them from visiting hospital. 71% of patients thought that PHDTS decreased their need to contact their GP. Conclusion: Patient satisfaction was high. PHDTS may augment selfmanagement strategies which can help to improve outcome. This survey suggests that pro-active PHDTS is effective in the management of patients with COPD. This could potentially reduce primary and secondary care attendances and healthcare utilisation. Conflict of interest and funding: Nil Corresponding author: Mr Kristopher Bahadur Email: kris.bahadur@gstt.nhs.uk Phone: 07967707472 Institution: Guy's and St. Thomas' NHS Foundation Trust Westminster Bridge Road London United Kingdom SE1 7EH 2. Step-down of well-controlled paediatric asthma patients in primary care: A pharmacist led primary care service Bhalla MK, Abdalla H Walsall Medicines Management, Walsall Clinical Commissioning Group (CCG) Brief outline of context: A pharmacist independent prescriber undertook a pilot project in two practices to identify well-controlled paediatric asthma patients and safely step-down their treatments Brief outline of problem: Accurately diagnosing asthma in children can be difficult leading to some receiving inappropriate diagnoses. Moreover, many young asthmatics outgrow their condition. Nevertheless, a structured step-down is seldom offered to these patients. Assessment of problem and analysis of its causes: Asthma UK reports 1.1million children with asthma but there is little information on how many are suitable for treatment step-down or how to do it safely Strategy for change: A pharmacist conducted consultations with selected patients to: • review medication • check inhaler technique, • conduct an Asthma control test (ACT) • issue a self management plan • implement treatment step down for suitable patients The pharmacist followed this with a telephone consultation 6-8 weeks later. Measurement of improvement: The methodology was reviewed weekly, based on attendance rates and number of patients stepped down. For those patients, ACT scores were recorded again at follow up. Effects of changes: 25 patients were seen and reviewed and all had concordance issues addressed. 14 (56%) of these were stepped-down, releasing efficiencies of £103.55/ month. All those stepped down had a follow-up ACT score of the same or higher, showing maintained asthma control Lessons learnt: Results highlight the gap in current service provision for stepdown in treatment in well-controlled paediatric asthma patients. Message for others: Many children diagnosed with asthma can be stepped down safely by a trained pharmacist, whilst consolidating concordance and releasing cost savings. Conflict of interest and funding: None Corresponding author: Ms Mindy Bhalla Email: Mindy.bhalla@walsall.nhs.uk Phone: 07843428487 Institution: Walsall clinical commissioning group Bloxwich lane Jubilee house Walsall United Kingdom Ws27jl 3. Are secondary care to blame for the large healthcare costs incurred by COPD patients? Bhogal P, Baker E St George’s University of London, United Kingdom Aim: Over £900 million is being spent on healthcare cost for COPD patients, over two thirds of which are encountered in secondary care. The new Wandsworth Tier System (based on NICE Guidelines) aims of reducing costs by providing guidelines to primary and secondary care in offering appointments to COPD patients. The aim of this audit was to determine whether COPD patients were seen by the correct healthcare professionals and were offered appointments efficiently in accordance to the new guidelines. Method: A cross sectional study was done where clinical letters from St George’s respiratory clinics over a 6 month period were searched to identify: all COPD patients attending clinic, the time and reason for those receiving follow up appointments. Demographic and spirometry results were recorded from electronic patient records. The proportion of patients offered a follow up appointment was determined, along with indications and mean time to the next appointment. Results: 169 cinics in 6 months were screened, with a total of 330 COPD patients seen (mean age 68 ± 11 years). 194 (59%) COPD patients were offered a secondary care follow up appointment. 19% of which were offered not in accordance with the new guidelines (including 7% unnecessary routine appointments). 28% of appointments were offered with inappropriate time intervals. Conclusion: 19% of appointments appeared unnecessary and referral of these patients back to primary/community care could increase the efficiency of the clinic as well as allowing patients to receive care closer to home. This would make clinic space for more timely follow up of patients needing appointments, hence improving use of healthcare resources. Conflict of interest and funding: Healthcare costs of COPD patients Corresponding author: Mr Palveer Bhogal Email: palvz4@hotmail.com Phone: 07908537742 Institution: St George's University of London Cranmere Terrace London United Kingdom SW17 0RE Copyright PCRS-UK reproduction prohibited http://www.thepcrj.org