Respiratory virtual clinics improve COPD care and add value

Multidisciplinary virtual clinics are an innovative way to bring together hospital lung specialists and primary care clinicians to improve the care of people with long term lung conditions like Chronic Obstructive Pulmonary Disease (COPD), according to a new study being presented at The British Thoracic Society's Winter Meeting.

COPD is a smoking-related condition affecting nearly one million people across the UK. There is wide variation in the management and outcomes of this condition.

Evidence suggests many patients do not always receive important support and treatment to help them stop smoking, and also exercise and education through a pulmonary rehabilitation programme.

Furthermore there is an over-reliance on inhaled corticosteroids (ICS) in their treatment. This is despite ICS only being effective with a small number of patients and amid increasing concerns about their side-effects (e.g. pneumonia) and costs to the NHS.

Local data, published by Dr Patrick White in Lambeth found that 38 per cent of COPD patients were over-treated with ICS.

This led to a new study, developed by King's Health Partners and Lambeth CCG, where the King's Health Partners Integrated Respiratory Team ran respiratory virtual clinics with primary care teams across Lambeth.

The clinics reviewed individual COPD patient case-notes and agreed treatment plans, including stepping down and stopping inappropriate ICS. This study brought about a significant reduction in high dose ICS prescribing and a consequent saving of £200,000 to the local healthcare economy.

In the study 94 per cent of Lambeth GP practices hosted a virtual clinic, and the researchers believe that if the findings were applied across the NHS, thousands of patients could have better, safer care and millions of pounds could be saved for reinvestment in effective treatments and services for COPD.

Grainne d'Ancona, principal pharmacist at Guy's and St Thomas' NHS Foundation trust, speaking on behalf of the King's Health Partners Integrated Respiratory Team, explains:

"Drawing on the expertise of respiratory specialists, we were able to change the focus of COPD care in a number of cases.

Where appropriate, the gradual withdrawal of inhaled corticosteroid treatment (ICS) was recommended; allowing patients to move away from high dose ICS, to effective interventions like smoking cessation and pulmonary rehabilitation.

As a result of this collaboration, Lambeth CCG reduced its high dose ICS prescribing from above the London average to well below it in a matter of months. These findings show that integrated working through respiratory virtual clinics offers huge scope to improve care for the population and maximise value within limited NHS budgets."

A survey, also presented at the BTS Winter Meeting (Wednesday 3 December) probing British Thoracic Society members' views on the role and benefits of integrated care, revealed that:

• Nearly 8 in 10 (77%) said that integrated care improved health outcomes for patients with a long term health condition
• Nearly 9 in 10 (87%) highlighted continuity of care for patients as a key benefit
• Nearly 9 in 10 (89%) agreed that integrated specialists improve relationships between primary and secondary care.

The BTS membership covers doctors, nurses, respiratory physiotherapists, scientists and other professionals with a respiratory interest. In total, 216 survey responses were received.

Professor Martyn Partridge, Professor of Respiratory Medicine at the National Heart and Lung Institute, Imperial College London, and Chair of The British Thoracic Society Working Party on Integrated Respiratory Care, said:

"Respiratory medicine covers a huge range of conditions from tuberculosis, COPD and lung cancer to asthma and sleep apnoea.

This diverse and demanding area calls on health care professionals to diagnose, manage and treat a huge range of diseases everyday. So the more we can work across both primary and secondary care, getting the specialist nearer to the patient, the better.

Virtual COPD clinics are a prime example of the positive work happening right now with specialists sharing their knowledge and expertise with GPs - benefiting both patients and the NHS.

There is a new need for enhanced training in delivering integrated care and the BTS has a Working Party to help take this forward. We believe that greater collaboration between respiratory specialists, primary care colleagues and community services will further improve the management of those with long term conditions.

As we move away from a rather hospital-centric model of specialist care we will provide resources that will assist respiratory teams to develop and continue programmes of integrated care across the UK."