Abstract
Introduction/ Background: The Respiratory Integrated Nursing (RIC) service was first established in 2021 in Dublin North (DN) in response to the Sláintecare Recommendations (1) and Integrated Care Programme for Chronic Disease (ICPCD) (2) which recognised the need to bring specialised COPD and Asthma services, closer to the patient's home. The Sláintecare vision is one of equal health service for all, providing “The Right Care, in the Right Place, at the Right Time” (1).
In Ireland there is estimated to be 500,000 people living with COPD but only 200,000 diagnosed. Furthermore Ireland has the 4th highest prevalence of Asthma worldwide at 470,000.
Thus the Community Teams were set up to act as a specialist support to General Practice and an important link to Acute Specialist Service. In 2021 in DN the Respiratory CNS began running satellite clinics close to the patients address to enable easy access to services for people with COPD and Asthma. This CNS service covers 5 community healthcare networks (CHN).
We wanted to review the effectiveness of CNS interventions on this cohort. We did this by reviewing exacerbation rates during the treatment period. We also collated CAT (COPD Assessment Test) /ACT (Asthma Control Test) scores pre and post intervention.
The COPD Assessment Test (CAT) is a questionnaire for people with Chronic Obstructive Pulmonary Disease (COPD). It is a subjective measure of the impact of COPD symptoms on a person's life, which can be measured over time.
The ACT is a patient self-administered tool for identifying those with poorly controlled asthma. The scores range from 5 (poor control of asthma) to 25 (complete control of asthma). Higher scores reflecting greater asthma control. An ACT score >19 indicates well-controlled asthma.
A difference in scoring of 3 for ACT (3) and 2 for CAT (4) is denoted as a clinically significant change. The Minimal Clinically Important Difference (MCID) assesses what change on a measurement tool can be considered minimal clinically relevant.
Methods: Retrospective data collection from our statistical database.
Results : A total of 136 patients reviewed have been discharged. 97 of these were COPD patients and 47 were Asthma patients, 66 achieved a Mean Interval difference (MID) CAT score and 31 achieved MID ACT score.
At discharge, 91 patients did not need to attend their GP due to an exacerbation, 3 patients attended Out of Hours services, 3 attended the Emergency Department and 5 attended hospital with an exacerbation, during the period of review.
Conclusion : In, conclusion, the nurse-led service provided a range of supported interventions over on average 3 visits (approx.12 weeks) for patients with a confirmed diagnosis of COPD &Asthma. This resulted in improved health status as demonstrated in patients CAT/ACT scores and exacerbation rates for the period of intervention. Patients were seen in Primary Care Centers close to their own home or as a home visit for those with severe disease. This enabled delivery of a specialist respiratory nurse- led service to patients in line with the ethos of Sláintecare, Right Care, Right Place, Right Time.