Abstract
Background: The Integrated Care Programme for Chronic Diseases (ICPCD) exemplifies the theme of collaborative approaches in integrated care by empowering asthma and COPD patients through self-management strategies and fostering collaboration with patients and advocacy groups. The programme prioritizes patient-centred care, involving patients in the design, delivery, and decision-making of healthcare within its Integrated Model of Care across Ireland. By leveraging partnerships, ICPCD aims to improve outcomes in both primary and secondary care. Active engagement with patients and advocacy groups ensures their experiences shape service design, delivery, and evaluation, driving continuous improvement and integrating patient voices into the care model.
Plan:
Collaborated with patient advocacy groups to incorporate the patient voice in asthma and COPD service design, emphasising shared decision-making.
Identified the need for innovative services, such as an asthma advice line and COPD support groups, to enhance care models.
Design:
Co-designed services with advocacy organisations, including the Asthma Society of Ireland and COPD Support Ireland, fostering collaboration in service development.
Developed e-referral pathways to facilitate access, ensuring a seamless patient experience.
Established dedicated contact points at respiratory hubs to coordinate services and provide effective signposting.
Implementation:
Launched the asthma advice line and COPD support groups across regions, reinforcing our commitment to collaborative care.
Integrated these services into Specialist Ambulatory Care Hubs, enhancing asthma and COPD management frameworks.
Results:
•In 2024, the COPD Support Groups and the Asthma Advice Line made significant strides in enhancing respiratory care.
•The COPD Support Groups delivered 1,547 in-person classes across 47 local support groups, along with 109 online classes. This outreach resulted in 14,668 total in-person attendees, including 300 new patients. Online participation also thrived, with 755 attendees, consisting of 10 new patients and 746 reviews. The group saw an 8.8% growth in classes delivered and a 24.2% increase in attendance in Q3 compared to Q1. Additionally, 130 referrals were received through the new healthcare professional e-referral form. There were 3,554 resources distributed to enhance support.
•The Asthma Advice Line recorded 751 calls in 2024, with 211 from first-time callers and 1,150 follow-ups. It addressed common concerns like nurse follow-ups and worsening conditions, facilitating 97 e-referrals since its February launch, with 46% from respiratory hubs. The Asthma Society of Ireland distributed 5,353 resources to enhance support.
Implications :
•Patient Partnership: Engaging service users as partners is essential to the health system and should be a foundational element of care delivery.
•Positive Impact of Advocacy Groups: The involvement of patient advocacy groups has demonstrated significant positive outcomes, underscoring the importance of recognising patients as experts in their own care.
•Integrated Model of Care: Our new model prioritises interdisciplinary collaboration, highlighting the necessity of ongoing patient involvement to enhance patient-centred care.
•Building Partnerships: Strengthening collaborations with respiratory advocacy groups is crucial to effectively address and respond to patient needs.
•Broader Application: Insights gained from respiratory care can inform partnership approaches in the management of diabetes and heart disease, promoting integrated service design and delivery across all ICPCD initiatives.