COPD Unmet Needs Project

1. COPD Unmet Needs Project Janet WinterRespiratory Facilitator, Dundee CHPValerie Spasic COPDNurse, Dundee CHPJohn WinterRespiratory Physician, Ninewells Hospital

2. Chronic obstructive pulmonary disease (COPD) • Prevalence • Dundee CHP COPD Programme • Aim, method and results of the unmet needs imitative

3. THE BURDEN OF COPD • COPD is joint fourth leading cause of death in the world1 • 32% of respiratory admissions are due to COPD2 • Currently under-diagnosed and under-treated, the burden of COPD is expected to rise in the future3,4 • 1 World health report. Geneva. WHO,2000 www.who.int/whr/2000/en/statistics • 2. Office for National Statistics. Mortality Statistics: Cause 1997; series DH2, No. 24, London, HMSO. • 3. World Health Report. Geneva: World Health Organisation 2000. Available from URL: http://www. who.int/whr/2000/en/statistics.htm. • 4. Murray CJL, Lopez AD. Lancet 1997; 347: 1498-1504.,

4. COPD Normal Definition of COPD • “COPD is a disease state characterised by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases.”1 • 1Pauwels RA, GOLD) Workshop Summary, Am. J. Respir. Crit. Care Med. 2001; 163: 1256-1276

6. Other environmental factors • Pollution • Low birth weight • Recurrent lrti in childhood • Low socio economic status¹ • Diet • Occupational exposure • Genetic/familial susceptibility • Alpha 1 antitrypsin deficiency ¹Kauffman et al

7. Presentation • Cough • Sputum production • Breathlessness • Loss of lung volume

8. Dundee COPD Programme • Improving patient quality of life and capacity for self- management • Improving access to practitioners with advanced skills and knowledge • Improving completeness of an accurate COPD register • Implementing evidence based medicine • Reducing episodic acute care in hospitals and the community • Improving the patient journey through better communication across professional boundaries

9. Attendance rates at practice based COPD clinics vary across the city with areas of high affluence achieving rates of >80% whereas rates in areas of high deprivation are <50%.

10. Aim of unmet needs project.. To increase uptake of COPD services in areas of high deprivation

11. Method • Respiratory project nurse appointed for 15 month study period • People were identified from 16 Practices who had not attended for a COPD assessment • The cohort were randomised into 3 groups • Letter • Telephone call • 2 contact visits • Assessment visit • Management visits

12. Randomisation

13. Demographics

14. 106

15. House visits-intervention group

16. Actions taken at house visits

17. 6 month follow up outcome

18. Reasons given for non-attendance • Family issues • Mental health issues • Complex health issues • Constant changeover of staff • Travel issues- difficulty and cost • Personality conflict • Carer • Housebound • Lack of understanding of condition • Working/shift pattern • In hospital • In prison

19. Conclusion Dedicated nurse telephoning and visiting patients in deprived areas allows approximately half to be contacted and a third to take part in a COPD assessment and treatment programme at home. The proportion of patients attending their general practice COPD clinic following the above COPD assessment and treatment programme at home is 59%, 20% greater than a comparable deprived control group who were contacted by letter only.