Specialist pharmacist “one-stop” primary care respiratory clinic- A new patient pathway to the management of high-risk respiratory patients. (ID 522)
Dudley Integrated Health and Care NHS Trust
Funding: None
Abstract
Background:Dudley in the West Midlands has some of the highest rates of hospital admissions and deaths related to asthma and COPD in the country. Several factors can lead to poorer respiratory outcomes for patients, such as delays in early and accurate diagnoses, incorrect diagnoses and suboptimal treatment and management.
Aims and Objectives:
Early and accurate diagnosis of asthma and COPD.
Identify misdiagnoses.
Identify and manage suboptimal asthma and COPD control including comorbidities.
Identify patients suitable for asthma biologics.
Improve the patient experience and health journey.
Method:
The clinic adopted a population health approach, using targeted searches to identify, risk-stratify and manage high-risk respiratory patients and vulnerable groups. Primary care clinicians can also make referrals to the service for patients who are difficult to treat or when there is uncertainty in diagnosis. A holistic approach was taken to manage patients including addressing comorbidities.
Patient experience was measured using a qualitative questionnaire and better symptom management based on quantitative outcomes such as improved symptom scores and reduction in reliever inhaler use.
Results:
• 198 patients were reviewed in the clinic.
• 64 were direct referrals from practice clinicians.
• Out of 111 patients with high SABA usage and other risk factors, 108 were effectively managed and 3 patients referred to secondary care.
• Out of 87 patients who were on SABA monotherapy without a confirmed respiratory diagnosis, 68 were diagnosed with asthma and 19 with COPD.
• 8 patients were identified as having a misdiagnosis of asthma or COPD.
• 19 patients were referred for consideration of biologic therapy following joint difficult asthma MDT meetings involving secondary/tertiary care.
• 69 patients were prescribed treatments to manage their comorbidities.
• Feedback from all patients was excellent.
Conclusion:
The clinic’s targeted approach demonstrates a successful and scalable model for integrated respiratory care.
Conflicts of interest: None (PCRS executive committee member)
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