Abstract
Introduction: In Ireland an estimated 380,000 people are living with Chronic Obstructive Pulmonary Disease (COPD) but only 110,000 are diagnosed[1]. Extensive under-diagnosis and misdiagnosis leads to patients receiving no treatment or incorrect treatment. Spirometry is vital to establish a diagnosis of COPD [2]. Appropriate and earlier diagnosis of COPD can have a very significant public health impact.
Aim: The aim of the study is to demonstrate that Respiratory Integrated Care Nurse Led Clinics enable earlier access to spirometry and earlier diagnosis via RIC consultant led multidisciplinary meetings (MDM). Data was collected on all patients reviewed in nurse led clinics.
Method: A retrospective review was carried out of patients referred from GP practices between May 2021 and May 2023, with a diagnosis of Chronic Obstructive Pulmonary Disease (COPD) or ‘query’ COPD, and no previous spirometry performed. Spirometry was requested and carried out in the Pulmonary Function Laboratory of the Mater Misericordiae University Hospital (MMUH) and all cases were discussed at our weekly integrated respiratory MDM.
Results: 99 patients were referred to RIC with a clinical diagnosis of COPD or ‘query’ COPD but no previous spirometry performed. Of these 99 patients, 64 (64.6%) were subsequently confirmed with a diagnosis of COPD. Global Initiative for Chronic Obstructive Lung Disease (GOLD) Grade 1: 22 (34.4%); Grade 2: 32 (50%); Grade 3: 9 (14%). 35 patients were not given a COPD diagnosis. Of these 35, 5 had no respiratory illness, 5 were diagnosed with asthma , 5 had probable asthma, 4 had obstructive sleep apnoea (OSA), 2 had asthma and OSA, 2 had rhinitis. One patient died of unknown cause and 11 did not attend, declined or were still awaiting spirometry at the time of abstract writing.
Key Learning: RIC nurse led clinics enables improved access to diagnostics and specialist input, which provides correct diagnosis and treatment. This provides an opportunity for secondary prevention and early intervention to minimise the impact of the disease process.
RIC centres nationwide will have access to spirometry within Integrated Care Hubs. Spirometry will then be more easily accessible to GP practices. In the near future Patient Satisfaction questionnaires will be utilised to gather further evidence of the effectiveness of the Respiratory Integrated Care Service.
References
1.National Clinical Programme for Respiratory End To End COPD Model of Care (December 2019). Available from: https://www.hse.ie/eng/about/who/cspd/ncps/ncpr/copd/moc/end-to-end-copd-model-of-care-december-2019.pdf
2.Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary. Eur Respir J. 2023 Apr 1;61(4):2300239. doi: 10.1183/13993003.00239-2023.