Working in Partnership

1
Working in Partnership

• Helping People
• Help Themselves
• Lavina Stallard

2
The Project Idea

• To develop an improved service for people
  diagnosed with C.O.P.D
• To help reduce acute admission to hospital
• To provide self help advise which will help
  people face changes in their lifestyle and to
  cope with their chronic condition.

3
The Objectives

• To develop the service within a Day Hospital
  environment using existing resources
• To follow N.I.C.E. Guidelines on the appropriate
  management of C.O.P.D
• To provide evidenced based information which will
  help improve quality of life issues and prevent
  unnecessary hospitalisation.

4
What is C.O.P.D

• Chronic Obstructive Pulmonary Disease
• is an umbrella term for a group of
• conditions, comprised of chronic
• bronchitis, emphysema and chronic
• asthma.
• It is characterised by airflow obstruction
• which is progressive, not fully reversible
• with symptoms that vary little from week
• to week (NICE 2004).

5
What are the symptoms ?

• Progressive breathlessness on exertion has been
  described as the main significant symptom of
  C.O.P.D.
• Fatigue and tiredness after very little effort.
• Avoidance of physical exercise, loss of
  confidence.
• Loss of appetite and weight loss.
• Forgetfulness/lack of concentration.
• Wheezing and coughing.
• Chest tightness, difficulty inhaling.

6
How is C.O.P.D diagnosed ?

• Smoking is now considered the major cause of
  C.O.P.D. (B.T.S. 2001). Establishing a smoking
  history, even if a patient has stopped, is
  important in the diagnosis.
• Spirometry is now one of the most important tests
  in the diagnosis of C.O.P.D, by measuring airflow
  and lung volumes (Bellamy and Booker 2004).
• Reversibility testing to differentiate asthma
  from C.O.P.D and identifying other areas such as
  occupational exposure and childhood illness.

7
How can C.O.P.D be treated?

• Early detection through screening. Most mild
  C.O.P.D. goes unrecognised, clinical signs are
  not always apparent until the disease is severe.
• There are, as yet, no drugs which can alter the
  rate of decline in lung function or significantly
  improve the disease.
• For smokers, stopping is the only way to slow the
  progression of the disease and return the natural
  decline of lung function to that of a non-smoker.

8
British Thoracic Society Guidelines of Management

• Early and accurate diagnosis.
• The best control of symptoms.
• Prevention of deterioration.
• Prevention of complications.
• Improving quality of life.

9
C.O.P.D.The Facts

• C.O.P.D. can only be confirmed through lung
  function tests
• Many people with COPD present late, between the
  ages of 50-70 years, many are asymptomatic until
  half the lung capacity has been lost, Fletcher
  and Peto (1977)
• C.O.P.D is no longer a hopeless condition Self
  management has been shown to be one of the ways
  to reduce both short and long stay
  hospitalisation. European Respiratory Journal
  (2003).

10
Plan of Care

• To refer to the Day Hospital for
  multidisciplinary assessment of needs
• Physiotherapy To measure physical effects of
  breathlessness and to provide evidence based
  exercise plan to improve stamina.
• Occupational Therapy To assess Psychological and
  social effects of breathlessness through impact
  questionnaires and to provide advise on quality
  of life issues.
• Nursing To monitor progress through medical
  assessments i.e. oximetry, self help
  advice,inhaler technique, specialist referrals

11
Locally-Llanidloes/Caersws

• Local GP catchment area population 8,000
• Known C.O.P.D 150 People
• Spirometry testing by Practise Nurses
• 2 community nurses trained in spirometry. Need
  appropriate spirometer for home testing.
• No Pulmonary Rehabilitation available
• Breathe Easy Group set up with BLF 2007 to be
  relaunched locally

12
Nationally

• COPD causes 30,000 deaths annually and is
  responsible for around 25 of all hospital
  admissions for respiratory disease. National
  Respiratory Training Centre (2005)
• It is estimated that medical admissions in the
  U.K cost the NHS 1,062 million per year.
  OReilly et al (2003).
• It has been estimated that there are over 3
  million people in the U.K with COPD, 2 million of
  who are unaware of their condition(British
  Thoracic Society (2004)

13
Self Help DVD

• Using evidence based information and expert
  patient advise the DVD aims to provide positive
  and pro-active solutions to help the person with
  COPD face changes in their lifestyle and take
  control of their condition. For more information
  on the development of the DVD please ask for
  further details on this stand.

14
Self Management

• Studies by Bourbeau et al (2003) showed that self
  management programmes reduced hospital use and
  improved health status more then usual care.
  Although self management interventions did not
  improve lung function or exercise capacity,
  exacerbations,hospital admissions and use of
  other health care facilities were reduced.