Effectiveness of community-based interventions following multi disciplinary team discussion in COPD patients

Abstract

Background: Chronic Obstructive pulmonary disease (COPD) results in frequent hospital admissions with a significant impact on quality of life. Glasgow Community Respiratory Team (CRT) manages COPD exacerbations at home with a multidisciplinary, patient centred approach. Patients failing to respond to appropriate management are reviewed at a weekly consultant led “virtual ward round”. Objectives: We aimed to evaluate the efficacy of introducing interventions in the community following MDT discussions as means of reducing hospital admissions and improving quality of life. Methodology: The data of 349 patients was accumulated from Glasgow CRT database from May 2017 to May 2018 who underwent MDT discussion due to failure to respond to CRT management. MDT outcome interventions were defined under the three main phenotypes which are asthmatic, infective and anxiety. We reviewed admissions number and COPD assessment score (CAT score) for 12 months pre and post MDT discussion. Results: The mean age was 69.7 (+/-10.1) and MRC Grade 4.3 (+/-0.6), 96% of patients were GOLD Cat D. Mean FEV1 was 53.7% (+/-21.9%), exacerbation frequency was 6/year. Admission rates reduced post intervention (1.4 vs 1.2 per annum p=0.0383). 176 patients were phenotyped as infective, 103 asthmatic, 7 anxiety. CAT score showed significant improvement post-intervention (29 vs 21.5 p Discussion: Community interventions reduced CAT scores and frequency of admissions in COPD. Virtual ward round review with identification and management of “treatable traits” may improve quality of life in a severe COPD patients managed in the community.