Southampton City PCT was highlighted in a BLF report as the only hotspot on the South Coast with a population at high risk of hospital admissions with an acute exacerbation of COPD (AECOPD). The reasons stated were a low number of registered COPD patients (1.5%), high smoking prevalence (32%) and deprivation. Predicted levels of COPD from local healthcare modelling were 6%. The trust was also experiencing a year on year increase of 15% in admissions for an acute exacerbation of COPD.Method
Southampton University Hospitals developed a primary care support team led by consultant respiratory physicians with support from respiratory nurse specialists to support primary care in the diagnosis and management of COPD. The education was delivered in a variety of formats from interactive lectures to groups of primary care doctors and nurses, small spirometry educational sessions with practice nurses, within practice education, locally led COPD diploma modules, and the development of a website (http://www.copdeducation.org.uk). The audit was performed on all admissions coded as COPD Exacerbation from the last 3 years and all notes reviewed to confirm diagnosis.Results
During the year long project COPD prevalence (from QOF) rose from 1.5% to 2.27%; an increase of 50%. The audit revealed several trends (1) admissions through the ED department rose by 10% each year from 2007 to 2010; (2) patients increasingly self presented to secondary care and (3) a large proportion of the admissions (22%) were due to a small number of frequent attendees (34 patients responsible for 176 admissions). We cohorted the frequent attendees and with a combination of discovery interviews and nursing/clinical support reduced admissions in this cohort by 78%). During this period COPD admissions reduced by 19% and 30 day readmission reduced from 13% to just 1.7%!Conclusion
Through the process of primary care education supported with other teaching modalities the diagnosis of COPD improved in Southampton. Medical intelligence of the admitted population combined with an appropriate intervention can reduce COPD admissions. This is just one of the ways the finding the missing millions part of the national strategy can be delivered.