Authors (including presenting author) :
Hui KW, Lai FS, Chan BY, Yip KY, Leung KH, Leung SH, Chen XRC, Li YC
Affiliation :
Dept. of Family Medicine and General Outpatient Clinics (GOPCs), Kowloon Central Cluster (KCC)
Introduction :
COPD care is very important in primary care and quality care is essential which involves multiple disciplines.
Objectives :
Objective: Chronic Obstructive Pulmonary Disease (COPD) is a common condition encountered in in the primary care. Starting from 1 April, 2017, COPD audit has been conducted across all GOPCs of HA to review the performance of COPD management in the community so as to provide information for better strategic planning and for quality improvement on COPD care. This study tried to audit the management of COPD cases managed at primary care clinics of KCC and to work out improvement strategies.
Methodology :
Methodology
Study design: clinic audit conducted at all 13 GOPCs of KCC.
Subjects: All COPD patients who were aged 40 or above and have attended KCC GOPCs for regular FU were included. Evidence-based audit criteria and performance standards were established after thorough literature review. The following 6 Audit criteria were used, they are:
1: percentage of patients with pre-scheduled appointments in GOPC;
2 percentage of smokers who have ever been referred to, or ever attended Smoking Counselling and Cessation Services (SCCS) before;
3: No. and percentage of patients with seasonal influenza vaccine given (SIV);
4: No. and percentage of patients with selected pneumococcal vaccine (PCV) ever given before;
5: percentage of patients with spirometry test done and
6: No. and percentage of patients admitted to hospitals due to COPD exacerbations (AECOPD).
Continuous
First-phase evaluation was performed in April, 2018 and deficiencies were identified. After 12 months of active intervention, second-phase evaluation was performed in April 2019. Chi squared test and student’s t test were used to compare the significance of relevant changes noted.
Result & Outcome :
Results: Totally 2,358 COPD cases were identified in the first phase, among which 1886 (80%) had prescheduled appointments in GOPCs. Among the 658 smokers, only 332 (50.5%) had been referred to SCCS and 289 (43.9%) actually attended the SCCS. In addition, less than half of them received SIV (n= 991, 42%) and PCV (n=938, 39.8%) respectively. Furthermore, only 698 (29.6%) patients had spirometry done before and 423 cases (17.9%) had been admitted to hospital due to AECOPD. After identifying these deficiencies, a series of improvement strategies were carried out to fill in the service gaps. Dept. COPD audit working group was formed in April, 2018, with dept. subject officer assigned. COPD patient lists of each clinic were shared out to clinic IC and APN IC to follow. Staff education on how to manage COPD and prevent its acute exacerbation were promulgated to all front line staffs. All COPD cases without a regular FU apt had been phone contacted by clinic nurses to enquire about their disease control and arrange FU if needed. All COPD cases were advised to receive SIV or PCV during their routine FU and referred to Nursing and Allied Health Clinic (NAHC) for spirometry if not done. What’s more, COPD cases were grouped based on their clinical severity and different level of care was provided accordingly. With all these concerted effort, second phase data showed significance improvement almost in all criteria. Among the 2,177 COPD cases identified in the second phase, 1,907 (87.6%) had prescheduled appointments in GOPCs (P< 0.00001). Almost half of them received SIV (n= 1,072, 49.2%) and PCV (n=1,244, 57.1%) respectively (both P< 0.00001). Furthermore, a dramatic improvement has been seen in boosting up the spirometry performance rate (n= 1,582, 72.7%) and a significant reduction in AECOPD rate (n=294, 13.5%, P=0.000043). However, the SCCS referral rate and attendance rate among smokers were comparable between the two phases (both P>0.05).
