Abstract
Introduction: Chronic Obstructive Pulmonary Disease (COPD) is the 3rd commonest cause of death worldwide and presents a great burden to sufferers and health care resource.1 Prior to COVID, General Practitioners were already struggling to systematically review and optimise care pathways for people with COPD.2 Post-COVID the face-to-face service and access to lung function has been further compromised. We present pilot data on the feasibility and acceptability of a virtual COPD review service.
Aims & Methods: A telephone triage template was piloted by a community pharmacist with patients over 12 months then had further stakeholder input from a respiratory physician, medicines management team and specialist respiratory nurses applying national3 and international1 COPD guidelines.
This template was used to guide phone consultations to patients on the GP Practice COPD register by either a practice-based pharmacist, GP practice nurse or a specialist community respiratory nurse. The project ran for 8 weeks, across three GP practices, covering a population 33,569 people in a semi-rural area of West Wales, UK.
Key Findings: Feasibility: of the known 869 total patients on the COPD registers, 157 (18%) were reviewed in just 8 weeks suggesting 100% could be reviewed within 44 weeks (an ‘annual review).
Acceptability: the service was popular with staff and patients. Of the first 85 medication changes, only 4 were switched back. There were no complaints.
Early impact:
a) non-pharmacological optimisation: 31% patients on the register actually had a diagnostic uncertainty; 18% had new referrals to smoking cessation,10% had new referrals to Pulmonary Rehabilitation and 15% had new referrals for winter vaccinations.
b) pharmacological optimisation: 53% had inhalers changed (combined multiple to single inhaler or cessation of inhaled steroids) leading to average cost savings of 3529 euros per Practice, per year and reducing carbon footprint.4
Conclusions: A co-developed and tested template helps guide COPD consultations and standardises approaches leading to significant challenges to original diagnosis and optimises both non-pharmacological and pharmacological treatment.
Implications for applicability/transferability, sustainability: The COPE template is feasible, acceptable and optimises COPD care that should improve outcomes and release resource. Results are being disseminated within the Local Health Board. The COPE service personalises care assessment and planning, supports self-management, helps staff work more efficiently through digital communication and tests an integrated workforce.