Authors (including presenting author) :
Dao MC(1), Fu SN(1), Luk W(1)
Affiliation :
(1)Department of Family Medicine and Primary Care, Kowloon West Cluster
Introduction :
Chronic obstructive pulmonary disease (COPD) is an important disease which poses significant burden to our health care system. Since 2016, our department haven taken initiative to improve the quality of COPD care through multidisciplinary care approach. Special integrated chronic disease clinics (ICDC) were set up in 3 general outpatient clinics (GOPCs) with the aim to provide comprehensive and multidisciplinary care for patients with COPD to reduce their symptoms, prevent exacerbation and improve their quality of life. To take a step further, we invited one doctor and one nurse from each GOPC to be responsible for improving COPD care in their clinics.
Objectives :
(1) To evaluate and compare the process and clinical outcomes in management of COPD in GOPCs in 2017/18 and 2018/19
(2) To determine the effectiveness of the strategies employed
Methodology :
Retrospective case reviews of COPD patients attending GOPCs were done, which included smoking status, vaccination status, spirometry reports and history of hospital admissions, through Clinical Management System (CMS) and Clinical Data Analysis and Reporting System (CDARS) from 1/4/2017 to 31/3/2019. Patients with specialist outpatient clinic follow up for COPD were excluded. Statistical analyses were done by SPSS.
Result & Outcome :
There were significant improvement of the process and clinical outcomes. The overall number of COPD patients attending KWC GOPCs were 1906 in 17/18 and 1565 in 18/19, with the majority (over 80%) being aged >= 65. The seasonal influenza vaccination rate among COPD patients improved from 46.0% to 53.4% (p< 0.01). The pneumococcal vaccination rate for aged >=65 improved from 46.3% to 72.5% (p< 0.01). The proportion of COPD patients with formal spirometry done rose from 28.1% to 51.5% (p< 0.01). The admission rate to hospital due to COPD exacerbations decreased from 11.7% to 9.5% (p=0.03). When comparing those GOPCs with ICDCs to those without, there were significantly more smoking cessation service referrals (59.8% vs 41.6%, p< 0.01), more spirometry done (61.4% vs 50.3%, p< 0.01) and more seasonal influenza vaccines delivered to COPD patients (72.0% vs 41.9%, p< 0.01). Conclusion: The strategies employed to improve COPD care were effective as reflected by the improved process and clinical outcomes, especially for those GOPCs with ICDCs. Further evaluation could be done to determine the sustainability of the ICDC model for management of COPD patients in primary care with multidisciplinary approach.
