A project to assess the effectiveness and feasibility of case finding of COPD by practice nurses

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A project to assess the effectiveness and
feasibility of case finding of COPD by practice
nurses
Delivery System Design -teamwork -role of
practice nurses
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• Faculty Research Grant 2007
• Jeremy Bunker, Nicholas Zwar, Sanjyot Vagholkar,
  Sarah Dennis, Guy Marks (UNSW)
• Alan Crockett (Uni. Adelaide)

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Background

• COPD.
• GPs and spirometry
• Barriers to Dx
• Evidence based treatment.
• GP workload..
• Practice nurse role and capacity development

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• Practices in South Western Sydney with
• Computerised medical records
• Practice nurse (s)
• Spirometer
• Practice nurses to
• Identify patients at risk of COPD
• Invite 100 to attend a case finding appointment
• Administer a questionnaire and spirometry
• Diagnose COPD, brief interventions for smoking
  cessation, referral to GP

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• Control strategy similar sized group of
  patients within each practice, not invited to
  screening notes reviewed at end of study period
  to determine rate of new diagnosis of COPD in
  this usual care group.

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Results

• 400 invitations to screening
• (4 practices - search strategy confirmed as
  feasible)
• 79 patients attended CF appointments
• 85 English as first language
• 34 smokers
• 16 acquired a new Dx of COPD (20 yield
  borderline/mild/moderate)

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• Feasible and efficacious?
• Yes
• Sustainable?

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• Nurses and practice staff
• Semi-structured interview
• Questionnaire

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Broad findingsHigh degree of enthusiasm and
acceptance

• Feasibility and acceptability
• acceptable and feasible a good learning
  experience for me
• more effective than usual practice
• I enjoyed the project x 4
• It was a lot of extra work but I think it was
  worth it
• it was a challenge professionally
• Administrative tasks in inviting patients
  tedious, but MS Word, Excel and mailmerge skills
  increased

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• Relevance to practice nurse role
• YES YES YES..really adds to the debate about
  developing and expanding the practice nurse role
• just what I already am planning to do anyway
• I never felt I was doing something weird or
  something not related to my work

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• Acceptability to patients
• Nurses were frustrated by poor patient response,
  but patients who attended seemed happy.
• Reluctance to address smoking they were quire
  happy to be tested although they rejected any
  smoking cessation advice when referring
  patients to GPs ..for smoking cessation and they
  would say, no, no dont bother

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• Other
• Recognised that research was different and
  could identify ways of simplifying or varying
  recruitment
• Opportunistic case finding
• Batching of invitations
• Simpler invitations
• Delegating to PM and reception staff the
  identification of patients at risk
• Phoning patients rather than mailing
• Reinforce recruitment with waiting room posters,
  brochures

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Bringing together a number of threads in COPD Dx
and Mx and smoking cessation.

• Specialist external nurses as case managers/care
  planners for patients with COPD
• Practice nurses and smoking cessation
• Practice nurse and COPD case finding.

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• A Randomised controlled trial of case finding by
  practice nurses of COPD, and early intervention
  by a GP-practice nurse team

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