COPD Unmet Needs Project

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COPD Unmet Needs Project

• Janet WinterRespiratory Facilitator, Dundee CHP
  Valerie Spasic COPD Nurse, Dundee CHP John
  WinterRespiratory Physician, Ninewells Hospital

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• Chronic obstructive pulmonary disease (COPD)
• Prevalence
• Dundee CHP COPD Programme
• Aim, method and results of the unmet needs
  imitative

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THE BURDEN OF COPD

• COPD is joint fourth leading cause of death in
  the world1
• 32 of respiratory admissions are due to COPD2
• Currently under-diagnosed and under-treated, the
  burden of COPD is expected to rise in the
  future3,4
• 1 World health report. Geneva. WHO,2000
  www.who.int/whr/2000/en/statistics
• 2. Office for National Statistics. Mortality
  Statistics Cause 1997 series DH2, No. 24,
  London, HMSO.
• 3. World Health Report. Geneva World Health
  Organisation 2000. Available from URL
  http//www. who.int/whr/2000/en/statistics.htm.
• 4. Murray CJL, Lopez AD. Lancet 1997 347
  1498-1504.,

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Definition of COPD

• COPD is a disease state characterised by
  airflow limitation that is not fully reversible.
  The airflow limitation is usually both
  progressive and associated with an abnormal
  inflammatory response of the lungs to noxious
  particles or gases.1
• 1 Pauwels RA, GOLD) Workshop Summary, Am. J.
  Respir. Crit. Care Med. 2001 163 1256-1276

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Other environmental factors

• Pollution
• Low birth weight
• Recurrent lrti in childhood
• Low socio economic status¹
• Diet
• Occupational exposure
• Genetic/familial susceptibility
• Alpha 1 antitrypsin deficiency

¹Kauffman et al
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Presentation

• Cough
• Sputum production
• Breathlessness
• Loss of lung volume

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Dundee COPD Programme

• Improving patient quality of life and capacity
  for self- management
• Improving access to practitioners with advanced
  skills and knowledge
• Improving completeness of an accurate COPD
  register
• Implementing evidence based medicine
• Reducing episodic acute care in hospitals and the
  community
• Improving the patient journey through better
  communication across professional boundaries

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Attendance rates at practice based COPD clinics
vary across the city with areas of high affluence
achieving rates of gt80 whereas rates in areas of
high deprivation are lt50.
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Aim of unmet needs project.. To increase uptake
of COPD services in areas of high deprivation
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• Method
• Respiratory project nurse appointed for 15 month
  study period
• People were identified from 16 Practices who had
  not attended for a COPD assessment
• The cohort were randomised into 3 groups
• Letter
• Telephone call
• 2 contact visits
• Assessment visit
• Management visits

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Randomisation
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Demographics
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106
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House visits-intervention group
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Actions taken at house visits
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6 month follow up outcome
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Reasons given for non-attendance

• Family issues
• Mental health issues
• Complex health issues
• Constant changeover of staff
• Travel issues- difficulty and cost
• Personality conflict
• Carer
• Housebound
• Lack of understanding of condition
• Working/shift pattern
• In hospital
• In prison

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Conclusion Dedicated nurse telephoning and
visiting patients in deprived areas allows
approximately half to be contacted and a third to
take part in a COPD assessment and treatment
programme at home. The proportion of patients
attending their general practice COPD clinic
following the above COPD assessment and treatment
programme at home is 59, 20 greater than a
comparable deprived control group who were
contacted by letter only.
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