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Symptom led services for breathlessness - real life examples
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Symptom led services for breathlessness - real life examples

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Symptom-led diagnostic services for breathlessness - real life examples - Wendy Fairhurst, Nurse Partner, Marus Bridge Practice

Symptom-led diagnostic services for breathlessness - real life examples - Wendy Fairhurst, Nurse Partner, Marus Bridge Practice

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  • 1. 1 Breathlessness Service Wigan Borough CCG Wendy Fairhurst Clinical Director Health First ALW CIC
  • 2. 2 Health Equity Audits COPD and Heart Failure  Deprivation  Low prevalence  High Admissions  Excessive mortality rates
  • 3. 3 Why Breathlessness?  Start from symptom based approach rather than disease based approach  Problems with multiple pathology  Problems with diagnosis between cardiac and respiratory causes of breathlessness  Multiple pathologies managed individually not holistically  Limited post-exacerbation follow-up in practice teams – many factors  No detailed personalised management plans
  • 4. 4 Feedback from Primary Care  Difficulties in the management of patients with multiple pathology  Patients referred to multiple hospital consultants and specialist nurses – inconvenience and confusing for patients – delays in appropriate treatment  Difficulties for some patients in accessing services  Travelling is difficult for this group of breathless patients  There are a high number of follow-up out-patient appointments. These are inconvenient for patients result in a high level of DNAs and are costly
  • 5. 5 The sort of support that practices need Diagnosing more difficult cases – this includes especially differentiating COPD from asthma and heart failure, but also other conditions. Doing reviews and optimising care on patients with multiple co-morbidities – especially lung disease, heart disease, other vascular disease, diabetes and CKD Doing reviews that go significantly beyond what is required for QoF – especially post exacerbation reviews that analyse causes of exacerbations and devise a plan for preventative measures Identifying high risk patients - Just working with those patients who have been admitted is not enough – most of the year’s admissions were not identified from the lists of previous admissions.
  • 6. 6 Principles  Integrated working  Early and accurate diagnosis  Service based in Primary Care  Active searching for patients in Primary Care who may be at risk of deterioration  Reviewing difficult cases in Primary by specialist nurses – working alongside practice teams  Giving each patient a self-management plan  Consultant – led clinics in Primary Care – leading to more integrated working  Reviewing patients post-discharge in Primary Care  Developing clinical resources for use within Primary Care
  • 7. 7 Integrated Working  Patient journey – not clear and equitable across the borough.  Working with other agencies ( Primary Care, Secondary Care, Tier 2)  Need to eliminate duplication
  • 8. 8 Early and accurate diagnosis  Previously 6 attendances to diagnosis  One stop shop diagnosis of Heart Failure and/or respiratory disease  Working with acute trust and community trust to deliver the service in Primary Care  Screening
  • 9. 9 Diagnostic Service Pathway
  • 10. 10 Service based in Primary Care  Support and mentorship. Up- skilling – working alongside staff in Primary Care  Training days  Key role of practice nurses  Mentorship for Gps and practice nurses  Training for practice staff
  • 11. 11 Active searching for patients who may be at risk of deterioration in Primary Care  Preventing deterioration  Searches  Not waiting for referrals
  • 12. 12 Assessment in Primary Care by Specialist nurse  Reviewing difficult cases in Primary Care by specialist nurses – working alongside practice teams (helps with up-skilling) – leading to more integrated working  Causes of exacerbations (medication/environmental)  Optimising medication  Patient education and empowerment  Giving each patient a self-management plan  Work with INT project
  • 13. 13 Developing clinical resources for use within Primary Care  Guidelines for the treatment of exacerbations  Cold weather warnings  Desk top guidance  Long term conditions template
  • 14. 14 Consultant – led clinics in Primary Care leading to more integrated working  Consultant – works in different practices around the locality on a twice monthly basis  Direct communication with GP’s and practice teams  Mentorship  Care Closer to home  2 week waiting list
  • 15. 15 Reviewing patients post-discharge in Primary Care  Preventing re-admissions and further exacerbations  Duplication  Working with Acute Trust
  • 16. 16 Pilot  £121k verified savings ( unscheduled admissions, outpatients and medicines management)18/24 practices.  £180 – estimated - if all 24 practices had been involved  12 month period ( 6 month set up time)  Based on one HRG code – J44 ( COPD admissions)  Initial difficulties in integrating with secondary care ( COPD unit, discharge information)
  • 17. 17 Diagnosis service results Referred to service New COPD COPD Diagnosis confirmed Treatment optimized New Asthma Asthma diagnosis confirmed treatment optimized Heart Failure Other DNA Under investigatio n 282 88 29 27 13 35 43 12 35
  • 18. 18 Qualitative results highlights  Improved data input and data collection in Primary Care ( e.g. recording of exacerbations)  Increased prevalence for all 3 diseases ( more accurate diagnosis, picking people up early, early treatment)  Average age of diagnosis reduced  Increased referrals to smoking cessation and pulmonary re-habilitation