A project to assess the effectiveness and feasibility of case finding of COPD by practice nurses

1. A project to assess the effectiveness and feasibility of case finding of COPD by practice nurses

2. Faculty Research Grant 2007 Jeremy Bunker, Nicholas Zwar, Sanjyot Vagholkar, Sarah Dennis, Guy Marks (UNSW) Alan Crockett (Uni. Adelaide)

3. Background COPD�. GPs and spirometry� Barriers to Dx� Evidence based treatment�. GP workload�.. Practice nurse role and capacity development�

4. Practices in South Western Sydney with Computerised medical records Practice nurse (s) Spirometer Practice nurses to: Identify patients at risk of COPD Invite 100 to attend a case finding appointment Administer a questionnaire and spirometry Diagnose COPD, brief interventions for smoking cessation, referral to GP

5. Control strategy � similar sized group of patients within each practice, not invited to screening: notes reviewed at end of study period to determine rate of new diagnosis of COPD in this �usual care� group.

6. Results 400 invitations to screening (4 practices - search strategy confirmed as feasible) 79 patients attended CF appointments 85% English as first language 34% smokers 16 acquired a new Dx of COPD (~20% yield ~=borderline/mild/moderate)

8. Feasible and efficacious? Yes Sustainable?

9. Nurses and practice staff Semi-structured interview Questionnaire

10. Broad findings:High degree of enthusiasm and acceptance Feasibility and acceptability �acceptable and feasible� �a good learning experience for me� �more effective than usual practice� �I enjoyed the project� x 4 �It was a lot of extra work but I think it was worth it� �it was a challenge professionally� Administrative tasks in inviting patients tedious, but MS Word, Excel and mailmerge skills increased

11. Relevance to practice nurse role: �YES YES YES..really adds to the debate about developing and expanding the practice nurse role� �just what I already am planning to do anyway� �I never felt I was doing something weird or something not related to my work�

12. Acceptability to patients: Nurses were frustrated by poor patient response, but patients who attended seemed happy. Reluctance to address smoking �they were quire happy to be tested although they rejected any smoking cessation advice� �when referring patients to GPs ..for smoking cessation and they would say, no, no don�t bother�

13. Other: Recognised that �research was different� and could identify ways of simplifying or varying recruitment Opportunistic case finding Batching of invitations Simpler invitations Delegating to PM and reception staff the identification of patients at risk Phoning patients rather than mailing Reinforce recruitment with waiting room posters, brochures

14. Bringing together a number of threads in COPD Dx and Mx and smoking cessation�. Specialist external nurses as case managers/care planners for patients with COPD� Practice nurses and smoking cessation� Practice nurse and COPD case finding�.

15. A Randomised controlled trial of case finding by practice nurses of COPD, and early intervention by a GP-practice nurse team