3-year evaluation of a primary care trust COPD health improvement programme

Abstract

Although respiratory diseases are not curently a priority in the national strategy for health, COPD imposes a considerable burded on patients and the health services and will focus in the proposed New GP Contract. A COPD Health Improvement Programme based on the BTS and GOLD COPD guidelines has been running for 3 years in the 18 practices of Wyre Primary Care Trust. A visiting, practice based spirometry service, nurse education programme and community pulmonary rehabilitation have enabled the delivery of guideline recommendations. A structured COPD programme based on accurate diagnosis, assessment, management and rehabilitation improves outcomes for patients and offers a model for Primary Care Organisations to commission and deliver high quality respiratory services. A population of patients, over 40, on respiratory medications, without a firm diagnosis of asthma, has been followed for 3 years. Patients are offered; diagnostic spirometric assessment, smoking cessation advice, therapy trials, secondary care referral where appropriate, annual practice nurse review, pulmonary rehabilitation with a continued weekly exercise classes. 2020 patients have been through initial spirometric assessment. Of these 242 (12%) had mild COPD, 525 (26%) mod COPD, 298 (15%) severe COPD. 414 (20%) were diagnosed asthma and 256 (23%) actually had normal spirometry. All smokers assessed have been offered smoking cessation support. 200 COPD patients have been referred to community pulmonary rehabilitation.140 completed and 8 week course and 50 continue to attend weekly exercise classes. Data on functional ability demonstrate that breathlessness scores show some improvement at all steps with the most significant improvement with pulmonary rehablilitation. The COPD Health Improvement Programme described provides an effective model of service delivery at Practice and PCT level, enabling the standards in the proposed New GP Contract to be acheived. Pulmonary Rehabilitation for patients who have been through a structured assessment, with appropriate therapy trials, appears to be the intervention that has the most positive impact on health status