INTEGRATED CARE PARTNERSHIPS
WIth aLmoSt 40,000 PEoPLE In nI dIagnoSEd WIth chronIc obStrUctIvE PULmonarY dISEaSE (coPd), and WIth thE dISEaSE accoUntIng for morE than tEn thoUSand admISSIonS to hoSPItaL Each YEar, It’S LIttLE WondEr that thE ProvIncE’S hEaLthcarE ProfESSIonaLS arE KEEn to fInd nEW InItIatIvES to aSSISt thIS cohort of PatIEntS. fortUnatELY, thE IntEgratEd carE PartnErShIPS (IcPS) arE aLrEadY maKIng an ImPact In thIS arEa…
IcPs provide a breath of fresh air
t
he three IcPs in the Southern trust area secured funding from their Local commissioning
group to pilot a rapid access respiratory clinic, which offered a new alternative for patients, rather than the traditional pathway of gP appointment, followed by referral to a & E and a likely hospital admission.
this new clinic meant that referrals were made in the morning by gPs and community respiratory teams for appointments on the same afternoon. the clinic was based at craigavon area hospital and comprised a consultant respiratory Physician, a Specialist respiratory nurse and a Specialist Physiotherapist operating on weekday afternoons.
the clinic enabled gPs to have a one- to-one discussion with a respiratory Physician, and provided a series of prompt interventions and early treatment regimes in a more integrated way. the patient was then referred on to the community respiratory team, which provided post-clinic treatments to enable the patient to remain at home.
during the pilot, which took place over a five-month period, 158 patients were treated at the clinic, avoiding a potential 78 hospital admissions and 336 bed days. Seventy respiratory patients were able
20 - PharmacY In focUS
to have a review of their medication at their local pharmacy in the craigavon/banbridge area on Saturday mornings to ensure they were receiving the optimum treatment and to encourage self management a part of a pilot service.
the accessibility of this service encouraged patients to participate rather than wait to see their gP on a week day, or miss their review appointment, potentially leading to a deterioration in their condition.
In the Western trust, meanwhile, two IcPs secured funding from their Local commissioning group for three community respiratory teams based at altnagelvin, tyrone county and South West acute hospitals to complement the existing Western trust respiratory service.
the creation of these teams meant that patients could be seen in a range of settings including their own homes, healthy living centres, clinics and gP practices. over the eight-month pilot, 818 patients were referred to the service, avoiding 739 hospital admissions and 4019 bed days.
the input of a dedicated respiratory pharmacist was shown to reduce the frequency of exacerbations or flare- ups from 65 per cent to 35.1 per cent, and to reduce the rate of
unscheduled hospital admissions from 8.4 per cent to 3.2 per cent.
In the belfast trust, people at risk of developing coPd are now being identified at an early stage through proactive ‘case finding’ at gP practices across belfast and in the northern trust area. this has enabled gPs to identify patients with the condition earlier and to provide treatment sooner.
additional Pulmonary rehabilitation (Pr) clinics in belfast and in the north have been put in place to increase the numbers of people benefitting from this treatment and provide a more integrated service.
Pr is a programme of exercise and education for people with long-term lung conditions, which combines physical exercise sessions with discussion and advice on lung health, and which has been shown to significantly reduce hospital admissions.
more than 250 patients across belfast have also been able to leave hospital earlier due to an extended community-based service, which has operated in the evenings and at weekends since January 2016. this extended seven-day community respiratory service has avoided 415 weekend admissions.
on a general basis, a home oxygen Service assessment and review (hoSar) service is now operating across northern Ireland to systematically review all patients with home oxygen for the effectiveness of their treatment, and to identify people who could benefit from home oxygen.
over 2700 people from the northern, South Eastern and belfast areas were assessed in 2015/16.
the work of the IcPs in the respiratory field has clearly shown that earlier intervention by specialised community respiratory services, along with increased access to rehabilitation programmes, are paying dividends for patients across nI and for the nhS budget in general!
StatIStIcS • coPd is the second most common cause of emergency admission to hospitals in nI
• there are 38,530 people currently diagnosed with the disease in nI
• twenty-five per cent of people with coPd are misdiagnosed
• In 2012/13, there were 10,133 admissions to hospital for coPd, taking up 69,099 bed days and an average length of stay of 6.8 days
• It’s estimated that 30 per cent of people on home oxygen derive no clinical benefit
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