Breakout 4.2 Optimise not maximise for better value COPD and asthma care - Noel Baxter
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Breakout 4.2 Optimise not maximise for better value COPD and asthma care - Noel Baxter

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Breakout 4.2 Optimise not maximise for better value COPD and asthma care - Noel Baxter ...

Breakout 4.2 Optimise not maximise for better value COPD and asthma care - Noel Baxter
Co-lead NHS London Respiratory Team
Part of a set of presentations from NHS Improvement event: Better value, better outcomes held on Thursday 21 February 2013,
Guoman Tower Hotel, London
How to deliver quality and value in chronic care:sharing the learning from the respiratory programme

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Breakout 4.2 Optimise not maximise for better value COPD and asthma care - Noel Baxter Document Transcript

  • 1. Optimise not maximise forbetter value COPD & asthma care Noel Baxter GP Co-lead NHS London Respiratory TeamThe VALUE equation HealthOutcomes Value Cost =Patient defined Health Outcomesbundle of care Cost of delivering Outcomes Porter ME; Lee TH NEJM 2010;363:2477-2481; 2481-2483 1
  • 2. We know what interventions are good value – when they are done in the right way Triple Therapy £35,000- £187,000/QALY LABA £8,000/QALY Tiotropium £7,000/QALY Pulmonary Rehabilitation £2,000-8,000/QALY Stop Smoking Support with pharmacotherapy £2,000/QALY Flu vaccination £1,000/QALY in “at risk” population What works long term and is cost effective?A cost effective intervention in COPD - Stopping Smoking 1 year abstinence QALY % £ Usual care 1.4 Minimal counselling 2.6 14,735 Intensive counselling 6 7,149 Intensive counselling + 12.3 2,092 pharmacotherapySystematic Review of 9 studies Hoogendoorn M, Feenstra TL, Hoogenveen RT, Rutten-van Mo¨lken MPMH.Thorax 2010: 65:711-718 2
  • 3. The low value pyramidWe know how to allocate resource atpopulation level http://www.impressresp.com/index.php?option=c om_content&view=article&id=167:impressions-28- relative-value-of-copd- interventions&catid=11:impressions&Itemid=3 3
  • 4. COPD in London: What do we know?Londoners dying from smoking ‘1 in 5 deaths due to smoking’ 4
  • 5. Stop smoking support: Step 1 treatment forpeople with asthma who smoke and forhouseholds of children with asthma thatsmoke“ 32.5% of patients admitted to hospital were current smokers …a further18.8% were ex‐smokers …a significantly greater number of asthmatics reportedthemselves to be smokers over the general population …… smoking causes steroid resistance in asthma and is associated with other‘risk’ behaviours, which may make this group more likely to be admitted tohospital Optimal healthcare for up to 1:4 people with a long term condition is stop smoking support as treatment 5
  • 6. Admissions ( asthma and COPD) : What factorscan we influence as health professionals ?• Bed capacity• Distance to hospital• Deprivation of population• Socioeconomic status• Prevalence of COPD• Prevalence of smoking in our practices Where can we make an impact for people with COPD and asthma ?• For every 1% increase in prevalence of smoking in your COPD population there is a 1% increase in COPD admission rates.• For every 1% increase in prevalence of smoking in your asthma population there is a 1% increase in asthma admission rates. 6
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  • 8. PCT monthly COPD dashboard 2013 Prevalence of current smoking where status 1550/3335 = 46.5% recorded in last 15 months COPD smokers in last year receiving evidence based stop smoking support – 17.5% Quit smoking as treatment Sharing Whittington learningHealth professionals esp doctors need to believe quit smoking interventions are part of their role & responsibility Behaviour change: importance, confidence Make it easy to do clinical leadership, systems & incentives• Brief interventions• Behaviour change skills• Knowledge of quit smoking services & referral• Prescribing knowledge & medications available• Measure outcomes and provide feedback• Acute Trust and Mental Health Trust CQINs 8
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  • 10. Are your hospital staff able, & confidentto, prescribe Quit Smoking medication? Does your hospital provide nicotine replacement therapy routinely on admission for smokers? How do we make this happen? 10
  • 11. What did we do?More about LRT and Right Care @www.londonrespiratoryteamconference.com 11
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