System of Shared Care - COPD

1. System of Shared Care - COPD Prototype Session 2 Westin Wall Centre Hotel June 16, 2011

2. Learning from each other: Changes in action Team report out Christina Southey

3. Team Kelowna

4. Team Kelowna • Dr. Phillip White • Mary Anne Sarin (MOA) • Laurie Sinclair M.Ed. • Todd Gale (RT) • Reed Scott (PSP) • Zahra Hussein (PSP)

5. Background information Dr. Phillip White (Rutland Medical) • 2500 FP patients • 125 COPD patients (5%) Todd Gale (RT) • COK Section Head for RT • Scope includes COPD, Primary Care…etc

6. Our team aim We aim to improve COPD case finding using the COPD-6 Spirometer with 25 patients by June 4, 2011.

7. Changes • Case finding approach using COPD-6 with 25 patients • Utilized NP/MOA to assist GP in COPD-6 screening

8. Our measures Dr. White’s Results • Among 25 patients trialed/screened with COPD-6: • 12 (48%) did not meet criteria for Spirometry testing referral • 13 (52%) did meet criteria and were sent to Pulmonary Lab for Spirometry testing

9. Our measures Todd Gale’s (RT) Results Test: Performed 11 COPD-6 + Spirometry tests on the same 11 patients to check for correlation Result: Good correlation…pretty good tool!

10. Patient story Jerry’s story (By Laurie and Dr. White)

11. Recommendations Recommendations for next test cycle • Things we would do again • Continue use of COPD-6 for screening • Support NP and MOA to conduct COPD-6 screening • Things we suggest not to do • None… just try it !

12. Summary of current status • Successes: • Great screening device • MOA/RN/NP can assist GP in COPD screening • Challenges and/or barriers: • COPD-6 can be time consuming (2-3 attempts) • IHA Pulmonary Function Lab capacity for Spirometry referrals • What we are planning to test next: • Utilize NP Clinic to conduct COPD screening

13. Cranbrook and Kimberley’s changes in action Interior Health

14. Our team

15. Cranbrook and Kimberley, East Kootenay • Rural full service family practice • Group practice • 25.2% of East Kootenay males smoke • High prevalence of COPD

16. Our team aim We aim to improve early detection of COPD in our practices using the COPD-6 so that all patients who are seen in the office who smoke or are over 40 with a cough will be screened by June 16, 2011. The COPD-6 will also be tested for its usefulness in family practice on 20 patients (per GP). We also aim to increase awareness and education to GPs and patients about COPD and services available.

17. Tests of change – Case finding • Lung Health Questionnaire • COPD-6 • MOA • Routine physical • Health Fair

18. Tests of change – Smoking cessation • Using lung age on COPD-6 • Referring to Quit Now • In office counseling

19. Patient story • 28 year old 2 pack per day smoker since the age of 12 • Lung age 82 years old • Quit smoking

20. Tests of change – Patient education • Recall/Follow up • Working with respiratory therapist

21. Tests of change – Specialist referrals • Inform GPs of Internal Medicine support for COPD clients • Remind GPs of referral criteria

22. Our measures COPD-6 device: • 45 patients in GP office • 20 patients by RT Smoking cessation: • 11 patients quit smoking (1 relapse) • 1 patient quit marijuana

23. Provider experience • Review of guidelines • More aware of screening and early detection of COPD • Increased confidence providing smoking cessation support • COPD-6 lung age creates an opportunity to break down barriers and provides an “in” • Surprised by number of colleagues patients who are not receiving guideline based care

24. Challenges • Fee code • Time • MOA buy in • GP colleague buy in • RT capacity • Internal Medicine capacity • Patients tend to respond better to GPs than others • Coordinating with other programs (GSK)

25. What we will do next • Meeting planned for September with GP community • Continue to build registry and screen all smokers over 40 • Set up recall system for COPD • Aim for 2 visits/year • Advanced Care Planning

26. Questions?

27. Team VIHA Dr. Frank Egan

28. What did I try/do? • I completed 60 COPD-6 tests ..found a way to make them fit into my daily routine for assessing my patients. 15% were positive - for COPD - 1/3 unexpected • Developed an emr button to record score for obs index and COPD-stage

29. What did I do? • Had several team meetings to develop an “optional” Respiratory Referral Form. • Introduced the COPD-6 screening device to 3 colleagues and set them up to start COPD screening. • Recruited a patient for COPD patient mapping and attended an afternoon mapping session.

30. COPD-6 (patient selection ) • Smokers and ex-smokers • Puffers • Unexplained shortness of breath (SOB) • History of pneumonia/lung injury • During full physicals • Group visit for diabetes –did 12 COPD-6 (3 positive -2 unexpected-) Think of it like blood pressure for cardiac assessment ..lung age for Respiratory assessment.

31. What is COPD?

32. The COPD-6 report • Sign ,show and state (3S) the meaning of the report • Flip to the Blank Side and ............S.T.A.R.T. • S. Set date • T. Tell (support people) • A. Avoid (triggers) • R. Relapse plan - go to S.- • T. What to take ...NRT, Champix, Zyban, etc

33. Copd-6 screening results

34. COPD-6 office demo

35. Quit quitting video Dr. Derek Poteryko

36. Lunch