P134 SPECIALIST CHRONIC DISEASE MANAGEMENT FOR CHRONIC OBSTRUCTIVE PULMONARY DISEASE REDUCES ADMISSIONS IN A SEMI-RURAL SETTING

¹C Hurlin, ²J Annandale, ³KE Lewis ¹Carmarthenshire Local Health Board, Llanelli, UK, ²Hywel Dda NHS Trust, Carmarthen, UK, ³Swansea School of Medicine, Swansea, UK

Background: Homecare for chronic obstructive pulmonary disease (COPD) has had mixed results depending on the setting and model applied.

Aim: To see if a specialist team, working in the community under clinical supervision by secondary care respiratory consultants, impact on COPD admissions.

Setting: Two UK district general hospitals serving a semi-rural population of 190 000.

Personnel: Two nurses and a respiratory physiotherapist, employed by the local health board (PCT) and coordinated by a manager whose background is specialist respiratory nursing. Each covers a geographical area of our county.

Criteria: They accept referrals from primary and secondary care if a COPD diagnosis is confirmed by spirometry, patients are on optimal therapy as per NICE guidelines but have any of: continued symptoms; recent admission from COPD; multiple exacerbations in the previous 12 months.

Process: Referrals are prioritised and seen by the team within 1 to 28 days, but not out-of-hours. The team has weekly meetings with rotating respiratory consultants, supported by direct access to the multidisciplinary hospital respiratory team for clinical advice, medicines prescription and radiology. They provide home visits (a clinical assessment and basic observations) and can bring prescribed medication to homes to treat exacerbations promptly; they provide telephone contact, education on COPD for patients/carers/relatives, reiterating advice on self-management, exercise and pulmonary rehabilitation and liase with GPs and other community health professionals. LTOT, domiciliary NIV and pulmonary rehabilitation are available locally.

Analysis: Retrospective review of admission data and clinical records.

Results: Over the first year they received 204 referrals; 15 were rejected. There were no reported adverse clinical events and a 32% reduction in COPD admissions to hospital. The table illustrates …