Practice Support Program in COPD: South Okanagan Project COPD CARE Algorithm

1. Practice Support Program in COPD: South Okanagan Project COPD CARE Algorithm South Okanagan, Interior Health Patricia Rattee RRT, CRE Shannon Walker MD, FRCPC Respirology

2. Why did we do this project? • COPD is under-diagnosed. • COPD is a chronic progressive respiratory disease for which guidelines recommend a chronic disease management approach through a multi-disciplinary team and patient self-management endpoints. • GPs may not have the time nor skills to promote self-management disciplines to their patients with COPD. • Tools currently exist for AECOPD discharge planning but not for early identification or management of the COPD outpatient.

3. What do we hope to achieve? • To promote early diagnosis of COPD in the community with a case finding approach and registry • To improve the care pathway of patients with COPD or suspected COPD through the GPs office • Develop relationships and care plans amongst family physicians, patients, specialists and acute care / community services • To promote and encourage optimal management of COPD patients according to national Canadian Thoracic Society COPD guidelines

4. 5 step OFFICE APPROACH VISIT 1: Patient Registry Burden of COPD Identification of Persons at Risk VISIT 2: Screening of Persons at Risk Smoking cessation COPD-6 or Spirometry VISIT 3: Confirmation Spirometry interpretation Assessment of level of disability VISIT 4: Management CTS guidelines for pharmacologic and non-pharmacologic treatment, ACTION PLAN VISIT 5+: Continuing Care Follow up, Rehab, Co-morbidities, End of Life

5. Visit 1: Identification • BE AWARE OF THE BURDEN OF COPD in Canada and world-wide • WHO IS AT RISK? • Formulate a patient registry • Identify smokers and ex-smokers in the practice • Have smoking cessation tools and contacts at hand • Bring patient at risk back for screening

7. Visit 2: Screening • To screen for COPD, airflow obstruction not fully responsive to BD needs to be demonstrated • Physical exam, Xray, nor smoking history alone confirms the diagnosis • COPD-6 is useful office tool for screening in suspected patients • Differentiate from other airway diseases, and other causes of SOBOE

9. Visit 3: Confirmation of COPD and Assessment of Severity • Does spirometry confirm fixed airflow obstruction post-bronchodilator? • Is the patient still smoking? • How severe is the FEV1? • How severe are symptoms and/or disability?

11. What constitutes “Severity”? • Lung function • Level of symptomatology • Level of disability • Co-morbidities • Exacerbations and hospitalizations • Systemic effects

12. Visit 4: Management of COPD • Do they have COPD? • Are they still smoking?* • Do they have symptoms? • Have they had an exacerbation in the past year? • Answers to the above determines the starting point for the management of COPD… • CTS management guidelines

13. Comprehensive Management of COPD GOLD stages (FEV1)I (>80%) II (50-80%) III (30-50%) IV (<30%)

16. Optimal Pharmacotherapy

17. CTS COPD Management Tool #20

18. Visit 5+: Continuing COPD Care and Tools • Prevention and Treatment of AECOPD • Management of progressive symptoms • Compliance and Medication Side-effects • Pulmonary Rehab • Respiratory Education • Patient Self-management and Action Plans • Re-assessment of lung function • Management of Co-morbidities • End of Life Care COPD CARE PROGRAM

20. Questions ???