copd英文课件】copd unmet needs project

,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,COPD Unmet Needs Project,Janet WinterRespiratory Facilitator,Dundee CHP,Valerie Spasic COPD,Nurse,Dundee CHP,John WinterRespiratory Physician,Ninewells Hospital,Chronic obstructive pulmonary disease (COPD),Prevalence,Dundee CHP COPD Programme,Aim, method and results of the unmet needs imitative,THE BURDEN OF COPD,COPD is joint fourth leading cause of death in the world,1,32% of respiratory admissions are due to COPD,2,Currently under-diagnosed and under-treated, the burden of COPD is expected to rise in the future,3,4,2. Office for National Statistics. Mortality Statistics: Cause 1997; series DH2, No. 24, London, HMSO.,4. Murray CJL, Lopez AD. Lancet 1997; 347: 1498-1504.,“COPD is a disease state characterised by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases.”,1,1,Pauwels RA, GOLD) Workshop Summary, Am. J. Respir. Crit. Care Med. 2001; 163: 1256-1276,Definition of COPD,COPD,Normal,Other environmental factors,Pollution,Low birth weight,Recurrent lrti in childhood,Low socio economic status,Diet,Occupational exposure,Genetic/familial susceptibility,Alpha 1 antitrypsin deficiency,Kauffman et al,Presentation,Cough,Sputum production,Breathlessness,Loss of lung volume,Dundee COPD Programme,Improving patient quality of life and capacity for self- management,Improving access to practitioners with advanced skills and knowledge,Improving completeness of an accurate COPD register,Implementing evidence based medicine,Reducing episodic acute care in hospitals and the community,Improving the patient journey through better communication across professional boundaries,Attendance rates at practice based COPD clinics vary across the city with areas of high affluence achieving rates of 80% whereas rates in areas of high deprivation are 50%.,Aim of unmet needs project.,To increase uptake of COPD services in areas of high deprivation,Method,Respiratory project nurse appointed for 15 month study period,People were identified from 16 Practices who had not attended for a COPD assessment,The cohort were randomised into 3 groups,Letter,Telephone call,2 contact visits,Assessment visit,Management visits,Deprived Interventional,Depcat 5-7,106,Deprived Non-Interventional,Depcat 5-7,48,Non-deprived Non-Interventional,Depcat 1-3,24,Randomisation,Demographics,106,House visits-intervention group,1,st,house call,2,nd,house call,N/a practice appt,N/a declined,Safety issue,Change of address,No reply card left,No reply,Declined,Visit success,12,10,1,5,37,7,2,29,3,2,31,4,31,4,3,Oxygen saturation measured,Spirometry,Change to medication,Smoking cessation advice,Referral for chest X-ray,Benefit applications,Referral - GP,Referral - pulmonary rehabilitation,Referral - comm. psychiatric nurse,Referral - continence advisory,n=32,29,26,25,21,15,13,10,5,1,1,Actions taken at house visits,6 month follow up outcome,Reasons given for non-attendance,Family issues,Mental health issues,Complex health issues,Constant changeover of staff,Travel issues- difficulty and cost,Personality conflict,Carer,Housebound,Lack of understanding of condition,Working/shift pattern,In hospital,In prison,Conclusion,Dedicated nurse telephoning and visiting patients in deprived areas allows approximately half 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 is 59%, 20% greater than a comparable deprived control group who were contacted by letter only.,