Natalie Janes and Lloyd Hambridge
Aneurin Bevan University Health Board
Watch Natalie and Lloyd talk about their project.
90% of COPD and Asthma patients are diagnosed within their GP practice. The provision of diagnostic spirometry across Primary and Community Care was severely disrupted by the COVID-19 pandemic. Spirometry was suspended in these settings in line with National Guidance and as a result, alternative methods to perform diagnostic spirometry was required.
This project introduced diagnostic spirometry hubs across ABUHB to undertake spirometry and fractional exhaled nitric oxide (FENO) testing, interpretation, confirm diagnosis and where necessary determine appropriate treatment and management pathways. Whilst also supporting the educational and training requirements for health care professionals
Project Aims and Objectives:
The key aim was to address the backlog of patients awaiting diagnostic spirometry testing within Primary and Community Care Services to:
- Reduce waiting list/time to test:
- Improve treatment outcomes, ensuring prudent prescribing/appropriate medicines management;
- Reduce A&E attendance, OOH, GP, and secondary care service contacts;
- Provide services and care closer to home in line with ‘a healthier Wales’;
- Ensure Primary and Community health care professionals are appropriately trained, certified, and have the required competence to undertake spirometry.
To ensure appropriate geographical coverage, two diagnostic hubs were set up in the North and South of ABUHB, operating 4 days a week.
The consultations were carried out by ARTP trained RGN/HCSW which allowed for comprehensive assessment, diagnosis, treatment, and management services.
Evaluation of the service was completed by collecting both quantitative and qualitative data. Patient satisfaction surveys allowed patients views of service and quality of care received to be collated, which supports continuous improvement methodology.
The diagnostic hubs in both the North and South afforded patients the opportunity to receive a diagnostic spirometry test during COVID-19 restrictions, supporting earlier diagnosis and onward care where required.
The developed model enabled improved capacity within secondary care and general practices, improving diagnosis, management, and treatment outcomes, which in addition supported practices to focus efforts on tackling the backlog of annual asthma and COPD reviews built-up during the pandemic.
- 347 risk stratified patients were reviewed of which 136 patients had a change in referral diagnosis. These patients were having significant symptoms affecting QOL.
- 31 of these patients had an admission to hospital and 7 had admission to ITU in past 12 months
- 104 patients had 2 more previous exacerbations in past 12 months.
- Provision of a prudent healthcare model has enabled patients to access specialist advice and services within Primary Care and Community settings, providing a more efficient service and shorter patient pathway.
- Detailed assessment and management of respiratory conditions completed targeting those with greatest need and diagnosis within a reduced timeframe compared to traditional models.
- Enhancement of the services that were previously available, providing future sustainability, and increasing capacity.
- Reduction in inappropriate referrals into specialist secondary care and consultant services, reducing costs to the NHS.