Aims:
The Practice Lincoln Green is situated in inner city Leeds and we have high levels of deprivation. Our practice prevalence for COPD is 3.9% with the national prevalence at 1.7%.
The Practice Lincoln Green is situated in inner city Leeds and we have high levels of deprivation. Our practice prevalence for COPD is 3.9% with the national prevalence at 1.7%.
14.2%
of patients on our practice COPD register have severe to very severe COPD. COPD
life expectancy is very difficult to predict due to the disease trajectory and
often doctors over-estimate survival.
There is reluctance to discuss respiratory patients at gold standards
meeting. Our aim was to improve the end of life care for our patients by using
the EQUIP worksheets.
Methods:
We used the PCRS EQUIP worksheets to help us identify patients approaching terminal stages of disease. The worksheets ensured we provided holistic reviews focusing on symptom management, medicines optimisation and referring to external agencies such as social services and palliative setting.
We used the PCRS EQUIP worksheets to help us identify patients approaching terminal stages of disease. The worksheets ensured we provided holistic reviews focusing on symptom management, medicines optimisation and referring to external agencies such as social services and palliative setting.
Results:
Every quarter the practice receives an MOT report from the CCG, highlighting smoking cessation rates and hospital admissions. Currently we have the highest levels of smoking cessation within the CCG and also have the lowest levels of hospital admissions. The number of people with respiratory disease discussed at gold standards meeting has increased, as has the number of patients with advance care plans and on the EPACCS template. We have also increased referrals to social services and third sector organisations. A small number of patients have also used the local hospice and one patient has moved to a nursing home, both of which have prevented admissions.
Every quarter the practice receives an MOT report from the CCG, highlighting smoking cessation rates and hospital admissions. Currently we have the highest levels of smoking cessation within the CCG and also have the lowest levels of hospital admissions. The number of people with respiratory disease discussed at gold standards meeting has increased, as has the number of patients with advance care plans and on the EPACCS template. We have also increased referrals to social services and third sector organisations. A small number of patients have also used the local hospice and one patient has moved to a nursing home, both of which have prevented admissions.
Conclusions:
The EQUIP worksheets are very quick and easy to use ensuring that patients receive the highest standards of care. Historically, resistance to discuss respiratory patients at GSF meetings has resulted in patients suffering with symptoms and struggling for longer. It is hard trying to change practice, but the worksheets have been invaluable at persuading clinicians without a special interest in respiratory care, that this is how patients should be managed. There is still some reluctance to prescribe opioids for breathlessness and in Leeds we do not have a dedicated palliative care team for respiratory. The worksheets have also made us realise there is a cohort of patients that would benefit from a breathlessness service such as the Cambridge Breathlessness Service, so we have contacted the commissioners to try and make the case for change.
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