It recommends that primary care must work in a much more integrated way with secondary care in order to more effectively manage the needs of this vulnerable group of patients.
Audit data collated during 2014 shows that:
- 43% of patients admitted for hospital treatment of COPD in 2014 were readmitted at least once in the three months following discharge, a 33% increase since 2008
- Over 50% of readmissions were in older people with multiple health conditions
The report says that potential reasons for the high admission and readmission rates are: ineffective discharge processes, poor coordination between primary and secondary care services, inadequate community service provision, lack of social care, reduced threshold for admission, or the fact that the patient cohort has become increasingly hard to support out of hospital.
Carol Stonham MBE, primary care respiratory nurse specialist in Gloucestershire and PCRS-UK nurse lead, says: ‘There is so much for people with COPD to gain if we work as this report suggests in an integrated way across traditional boundaries.’
‘Whatever the reasons, the overriding impression provided by the data is of a system that is not only stressed, but is ultimately failing COPD patients,’ it warns.
The PCRS-UK view:-
- We support this report and recognise the important part primary care has to play in some of the key recommendations:
- earlier identification of COPD and targeted support of people at highest risk of admission
- helping patients access high value interventions such as pulmonary rehabilitation and tobacco dependency treatment
- co-ordination of multidisciplinary assessment of people with multiple healthcare needs and conditions
- We welcome the emphasis on integrated approaches to supporting people with COPD and agree that it is only by working together across boundaries that a truly patient centred approach and improved outcomes can be realised.
- We agree that high admission and readmission rates imply that holistic care across boundaries is not always being provided, and that a ‘stressed system’ means that appropriate solutions to addressing the problems of repeat attenders to hospital are not being found.
- Clinicians, commissioners and social care providers need to work together within local health economies to develop pathways and systems which will improve outcomes and wellbeing in this vulnerable group of patients.
Make sure your practice has systems in place for:
- Early review of every discharged case (within 7 days)
- Earlier identification of COPD and targeted support of people at highest risk of admission
- Ensuring patients access high value interventions such as pulmonary rehabilitation and tobacco dependency treatment
- Coordinating multidisciplinary assessment of people with multiple healthcare needs and conditions
‘COPD: Who cares when it matters most?’ National COPD Audit Programme: Outcomes from the clinical audit of COPD exacerbations admitted to acute units in England 2014 is available HERE