Source: International Congress 2014 – Management of asthma and other respiratory diseases in primary care
Disease area: Airway diseases

Abstract

Introduction:Integrated Respiratory Consultant roles have been promoted alongside the shift in chronic disease management to primary care. Defining the value of these roles is challenging. This retrospective qualitative analysis documents interventions made by an integrated consultant working with a community based MDT commissioned by local GPs.Methods: Case discussion records from weekly MDT meetings from January 2012 to July 2013 were reviewed noting referral source, disease severity, smoking status. Key outcomes of meetings were quantified thematically: 1. New diagnoses made 2. Evidence-based management interventions 3. Interventions to improve quality or coordination of careResults: 122 patients were discussed, 66 referred by GPs, 37 by secondary care and 19 by pulmonary rehabilitation. Median age (range) 73 (41-97) years. Referral diagnoses were: COPD [87]; COPD plus bronchiectasis [26]; interstitial lung disease [6]; asthma [3]. In patients with COPD, mean FEV1 % predicted(SD) 42.4(15.4)%. 40 patients were smokers. Outcomes: 14 new respiratory diagnoses, 164 evidence-based management interventions, 64 referrals to improve coordination of care. Mortality was low (3 patients).Conclusions:Patients referred had severe and/or complex disease and challenging psychosocial needs. Integrated consultant input improved quality and coordination of care. In response to identified unmet needs service improvements have been made: psychology supported stop smoking; stop smoking specialist for housebound patients; long term exercise post PR; AECOPD pathway to support recovery and avoid hospital admissions. Defining the value of these interventions remains challenging.

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M. Heightman, B. Flint, J. Edwards, J. Dzingai, G. Fabris, E. Jones, M. Stern (London, United Kingdom). Measuring the value of integrated respiratory consultant support of a community respiratory multidisciplinary team (MDT). Eur Respir J 2014; 44: Suppl. 58, 3029

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