The Burden of COPD
COPD is thought to be the fourth leading cause of death worldwide; the World Health Organisation predicts that by 2020 it will have become the third.
In the UK, approximately 900,000 people are diagnosed with COPD.
The disease is closely associated with levels of deprivation; higher incidence occurring in more deprived areas. COPD is responsible for 30,000 deaths and is responsible for 1 in 8 (130, 000) emergency admissions per year in the UK.
£491 million NHS direct costs, 1.4million GP consultations each year
Accounts for >one million ‘bed days’ each year in hospitals in the UK
The Local Perspective
- Dudley PCT serves a population of 315,000 people
- As of March 2011, 4915 patients were listed on COPD registers (QOF data)
- Hospital admissions for all COPD exacerbations cost the local health economy £750 000
- Each admission costs approx £2,200
Why Have a LES?
- Primarily to reduce avoidable hospital admissions
- Develop and deliver integrated patient focused services, for individuals with COPD, providing efficient, high quality evidence-based care
- Offer care close to home that is ‘co-ordinated’ by general practice
Practices who sign up to the LES will have to nominate an identified lead for COPD, who will have or be working towards COPD diploma or equivalent
- Patients diagnosed with COPD will be graded for severity:
Mild, Moderate Severe or Very Severe
- Mild moderate and severe patients – 1 x annual review
- Severe patients – 2 x annual review
- Each practice to develop a High risk of Admission Register
Each review must include the following:
- Breathlessness Score – MRC
- Inhaler Technique
- Treatment review as per local guidelines
- Record number of exacerbations
- Record hospital admissions with exacerbation of COPD
- Stand by antibiotics' & steroids as appropriate
- Pulse Oximetry & Referral for ABGs if indicated
- Offer referral to pulmonary rehab if appropriate
- Offer appropriate referral to exercise programmes
- Self management plans provided for individuals
- Patient education
- Smoking Cessation Referral
- COPD Assessment Tool (CAT) Score
Dudley COPD Guidelines
All patients to be managed according to the ‘Guidelines for the Diagnosis, Management and Treatment of Chronic Obstructive Pulmonary Disease (COPD) In Dudley’
High Risk of Admission Register
On developing a ‘high risk of admission register’, practices should include the following criteria (guideline criteria only)
- Previous admission in the past 12 months (8H2R)
- BMI < 20
- Severe COPD
- Clinically indicated
Code 14OZ - H/O Risk Factors NOS (enter under problems as this will alert staff)
In order to maintain quality of care and standardise treatment in accordance with best practice, it is essential that each practice identifies a nominated lead. This individual will need to undertake (or will need to have undertook) the following training:
- COPD Diploma or equivalent (i.e. Education for Health COPD Diploma)
- In house training – Professional Development & Education
1st April 2011 31st March 2012
- Mild/Moderate/Severe Reviews - £45.00 claimable once yearly
- Very severe Patient Reviews - £100.00 claimable twice yearly
The Treatment of Exacerbations in COPD...
Diagnosing Severity of COPD...
Identifying Patients who are at High Risk of Admission...
Management of Stable COPD...