A community based service for management of COPD was commissioned to start in July 2011. The service uses an integrated multi-disciplinary approach and is run by community based specialist respiratory nurses, supported by a secondary care respiratory medicine consultant. This includes a weekly MDT meeting and consultant led clinic. The service can offer home visits and works closely with other community based teams including pulmonary rehabilitation, community matrons, smoking cessation services and dietetics. A review of the first six months of new patient referrals has been completed. In the first 6 months of the service 68 new patients were seen in clinic of whom 64 were diagnosed with COPD. Patients mean age was 68 years and mean predicted FEV1 45%. There was a high burden of disease, with a mean COPD assessment test (CAT) score of 21, and over 95% of patients having a CAT over 10. All patients were provided with a written self management plan. 29 patients were seen on more than 1 occasion and of these 55% had a clinically meaningful improvement in CAT (reduction of 2 or more points). Hospital admissions were compared in the 12 months prior to first appointment and the 12 months after. The number of admissions fell from 40 to 31 (22% reduction) and total number of hospital bed days fell from 217 to 166 (24% reduction). There were few response to the electronic patient feedback system, but responses that were received were generally positive. A community based multi-disciplinary integrated COPD service is effective at reducing hospital admissions, improving quality of life, and is acceptable to patients.
Hardy et al. (Sun,) studied this question.