Hospital Dr News

Integrated care key to improving respiratory med

Multidisciplinary virtual clinics are an innovative way to bring together hospital lung specialists and primary care clinicians to improve the care of people with long term lung conditions like Chronic Obstructive Pulmonary Disease (COPD), according to a study.

COPD is a smoking-related condition affecting nearly one million people across the UK. There is wide variation in the management and outcomes of this condition.

Evidence suggests many patients do not always receive important support and treatment to help them stop smoking, nor exercise and education through a pulmonary rehabilitation programme.

Furthermore there is an over-reliance on inhaled corticosteroids (ICS) in their treatment. This is despite ICS only being effective with a small number of patients and amid increasing concerns about their side-effects (e.g. pneumonia) and costs to the NHS.

The study, developed by King’s Health Partners and Lambeth CCG, and presented at the British Thoracic Society’s Winter Meeting, shows that ‘virtual clinics’ that review individual COPD patient case-notes and agree treatment plans, including stepping down and stopping inappropriate ICS, reduced high dose ICS prescribing and a consequently saved £200,000 to the local healthcare economy.

In the study 94% of Lambeth GP practices hosted a virtual clinic, and the researchers believe that if the findings were applied across the NHS, thousands of patients could have better, safer care and millions of pounds could be saved for reinvestment in effective treatments and services for COPD.

Grainne d’Ancona, principal pharmacist at Guy’s and St Thomas’ NHS Foundation trust, speaking on behalf of the King’s Health Partners Integrated Respiratory Team, explains: “Drawing on the expertise of respiratory specialists, we were able to change the focus of COPD care in a number of cases.

“Where appropriate, the gradual withdrawal of inhaled corticosteroid treatment (ICS) was recommended; allowing patients to move away from high dose ICS, to effective interventions like smoking cessation and pulmonary rehabilitation.

“As a result of this collaboration, Lambeth CCG reduced its high dose ICS prescribing from above the London average to well below it in a matter of months. These findings show that integrated working through respiratory virtual clinics offers huge scope to improve care for the population and maximise value within limited NHS budgets.”

Another survey presented at the meeting reveals that nearly 8 in 10 (77%) said that integrated care improved health outcomes for patients with a long term health condition, with 87% highlighting continuity of care for patients as a key benefit.

Professor Martyn Partridge, Professor of Respiratory Medicine at the National Heart and Lung Institute, Imperial College London, said: “Respiratory medicine covers a huge range of conditions from tuberculosis, COPD and lung cancer to asthma and sleep apnoea.

“This diverse and demanding area calls on health care professionals to diagnose, manage and treat a huge range of diseases everyday. So the more we can work across both primary and secondary care, getting the specialist nearer to the patient, the better. Virtual COPD clinics are a prime example of the positive work happening right now with specialists sharing their knowledge and expertise with GPs – benefiting both patients and the NHS.”

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