Appendix Q. Tayside Health Board - Improved Access to COPD Services
Topics: Mental Health; Primary Care; Substance Misuse
Background
Chronic Obstructive Pulmonary Disease ( COPD) is joint fourth leading cause of death in the world, with 32% of respiratory admissions due to COPD. At present it is under-diagnosed and under-treated and given that one of the primary causes for COPD is smoking, the burden of COPD is significant, especially in Dundee which has rates of smoking higher than the national average.
In Dundee, attendance rates at practice based COPD clinics varied, with areas of high affluence achieving rates of +80%, whereas areas of high deprivation are less than 50%.
Funding allocation
The pilot was allocated £45,000
Aim(s)
To increase uptake of COPD services in areas of high deprivation in Dundee.
Methodology
A respiratory project nurse appointed for study period. A quasi-experimental design used in which people from 16 practices in Dundee who had not attended a COPD assessment were identified. Clients were then put into one of three groups -
- Deprived intervention (Depcat 5-7) = 106
- Deprived non-intervention (Depcat 5-7) = 48
- Non-deprived non-intervention (Depcat 1-3) = 24
The primary outcome for the project measured uptake in services defined as meeting for assessment and attendance at 6 month follow-up.
The secondary outcomes of the project were the number and socio-demographic distribution of: patients contacted; patients who were contacted and offered follow-up services; patients who attended follow-up services and patient views regarding acceptability.
Key results
Dedicated nurse telephoning and visiting patients in deprived areas allowed approximately half of identified patients in the deprived intervention group to be contacted and a third to take part in a COPD assessment and treatment programme at home.
The proportion of patients attending their general practice COPD clinic following the above COPD assessment and treatment programme at home was 59% which was 20% greater than a comparable deprived control group who were contacted by letter only.
Conclusions
The project highlights that taking small steps to make contact with persistent non-attenders may be a productive approach.
However, in considering reasons for non-contract and attendance, the project noted the variety of complex health issues associated with condition e.g. 54% of identified patients had mental health problems and 23% had alcohol dependency syndrome.