Roger Beech Rosie Piggott Plus Sue Ashby Carolyn Chew-Graham Faye Foster Alison Pooler

1. Applying best practice for the care of patients with Chronic Obstructive Pulmonary Disease (COPD) Roger Beech Rosie Piggott Plus Sue Ashby Carolyn Chew-Graham Faye Foster Alison Pooler

2. Burden of COPD • Around 835,000 individuals in the UK diagnosed with COPD (with an estimated 2,200,000 undiagnosed). • Causes irreversible damage to airways, persistent cough and breathing difficulties. • Second largest cause of emergency hospital admissions in the UK. • Leads to lower self esteem and reduced participation in social activities. • Causes around 23,000 deaths per year in England but around 7,500 regarded as “avoidable”. An outcomes strategy for people with chronic obstructive pulmonary disease (COPD) and asthma in England (Department of Health 2011).

3. But… Estimated that burden of COPD for individuals and health services could be reduced by: • The greater adoption (by professionals and patients) of evidence-based practice for preventing, detecting and treating COPD. • Improved integration of services available for the care of patients with COPD. An outcomes strategy for people with chronic obstructive pulmonary disease (COPD) and asthma in England (Department of Health 2011).

4. Encouraging best practice Recent/ current projects: • HIEC training initiative. • Stoke CCG Pulmonary Rehabilitation project.

5. HIEC training initiative • Delivered February to June 2012. • Targeted at primary care practices with high prevalence and admission rates (12 recruited). • Goal was to increase awareness of evidence based practice and generate behavioural change amongst professionals. • Designed and delivered in collaboration with local health professionals and patient support groups. • Incorporated interactive taught sessions and local service delivery projects.

6. Impact Was the course valued? “It was a really good course. Nice to see such a variety of things – rehab, spirometry; breathe easy; so broad it was very good” PN. Did attendees put learning into practice? “Practice with patients definitely improved, I can now advise about symptoms and have confidence to talk about symptoms like breathlessness’” PN. Did organisational practice change? “We’ve improved our screening and our pick-up rate; our diagnosis and prevalence of COPD have improved. We also picked up ideas from other attendees such as, we now have rescue packs”. GP.

7. What were the key drivers of change? • Patient involvement “training days are good but are usually from a medical point of view whereas having patients involved and telling us what works and what doesn’t was really good, I found myself thinking I do that with patients and I’d better change it” PN. “We do all these things to people, at people, we don’t often get the opportunity to listen to people and listen to how it impacts them and their family” PN. •  Local speakers “Local speakers were invaluable; they speak the same local dialect and can say where things are being held and talked about local people” PN. • Project.

8. Pulmonary Rehabilitation (PR) Project Stoke CCG Innovation Funding

9. Pulmonary Rehabilitation: what’s the problem? A typical practice: • 168 eligible patients. • 65 had no documented discussion or offer of referral. • 87 declined a referral. • 16 referred/completed PR.

10. Iterative project with 8 practices that involves: Baseline and ongoing assessment of practice. Actionable suggestions to practices. Discussions with Breathe Easy group/ Patient interviews. Fine tuning suggestions package. What are we doing?

11. Local Baseline Findings: • Similar to wider literature with low referral rates and poor coding. • GPs tend to have poor knowledge of PR. • Nurses generally more conversant with PR and the referral process. • PR is under publicised compared to eg smoking cessation. • Lack of clear referral guidelines within practices.

12. In a nutshell: Pulmonary Rehabilitation Monitor Eligible Patients Re-Design Re-Design Current Practice Patients Staff Academics

13. Any questions?