Improving the experience of all Londoners with COPD and minimising the impact of the disease London Respiratory Team Primary Care Intelligence A GP Perspective with a COPD focus Dr Noel Baxter, Surrey Docks Health Centre & London Respiratory Team

London Respiratory Team COPD in London: what do we know? 7,619,800 Londoners Mid-2008 population estimate How many are living with COPD?

London Respiratory Team 24 Recommendations included in Operating Framework Dec 2010

Improving the experience of all Londoners with COPD and minimising the impact of the disease London Respiratory Team Right Care Priorities Pulmonary Rehabilitation Responsible Respiratory Prescribing Responsible Oxygen Prescribing Stop smoking support and therapy as treatment for COPD

Improving the experience of all Londoners with COPD and minimising the impact of the disease London Respiratory Team Using APHO Profiles in COPD COPD in Primary Care… A slow awakening Getting motivated Changing attitudes Less interest in LOS/Admissions

Improving the experience of all Londoners with COPD and minimising the impact of the disease London Respiratory Team Using APHO Profiles What works well… Adds value to QOF data Compare practices using local knowledge Visually useful for overall picture

Improving the experience of all Londoners with COPD and minimising the impact of the disease London Respiratory Team Using APHO Profiles What needs to be reviewed… QOF too easily achieved Not enough reds and greens Looks like everyone the same

London Respiratory Team COPD 13: A review including MRC score Not required for QOF

London Respiratory Team COPD 10 &12: FEV1 at diagnosis and every 15 months Not required for QOF

London Respiratory Team Not required for QOF Evidence based therapy

Improving the experience of all Londoners with COPD and minimising the impact of the disease London Respiratory Team Interpreting APHO Profiles

London Respiratory Team 09/10Exception rate (%) No of exceptions CVD primary prevention ,103 Heart failure ,808 COPD ,939 Mental health ,104 Epilepsy ,80

Improving the experience of all Londoners with COPD and minimising the impact of the disease London Respiratory Team Exception reporting in COPD Nihilism in both parties Housebound – Silo working Confusion around diagnostic criteria Is it a marker for quality of care?

Improving the experience of all Londoners with COPD and minimising the impact of the disease London Respiratory Team Exception reporting review All years: 13 patients exception reported without valid justification 8: Conflict about diagnosis 1: Patient too frail 4: No clear justification

Improving the experience of all Londoners with COPD and minimising the impact of the disease London Respiratory Team Interpreting APHO Profiles Achieved QOF for ‘ inappropriate’ exception reported patients

London Respiratory Team COPD measures in primary care (Wish list) Prevalence of smokers in COPD register Offer and provision of effective stop smoking treatment Prescribing data Measuring outcomes –Completion of pulmonary rehabilitation –Quit smoking at 1 year –PROM –Hypoxia Assessed –CO Measured –Stratification using MRC scores

Improving the experience of all Londoners with COPD and minimising the impact of the disease London Respiratory Team Stopping smoking works… Fletcher, Peto: Br Med J 1977; 1 :

Improving the experience of all Londoners with COPD and minimising the impact of the disease London Respiratory Team Long-term effectiveness and cost effectiveness of smoking cessation interventions in patients with COPD 1 year abstinence % QALY £ Usual care1.4 Minimal counselling2.614,735 Intensive counselling67,149 Intensive counselling + pharmacotherapy 12.32,092 Tiotropium QALY £7,112 Eur J Health Econ. 2007; 8(2): Hoogendoorn M, Feenstra TL, Hoogenveen RT, Rutten-van Mo¨lken MPMH Thorax 2010: 65:

Improving the experience of all Londoners with COPD and minimising the impact of the disease London Respiratory Team Explaining Variance and aligning data

Improving the experience of all Londoners with COPD and minimising the impact of the disease London Respiratory Team Explaining Variance and aligning data

Improving the experience of all Londoners with COPD and minimising the impact of the disease London Respiratory Team Explaining Variance Current Smokers

London Respiratory Team Explaining Variance Never Smoked

Improving the experience of all Londoners with COPD and minimising the impact of the disease London Respiratory Team What do we know: Smoking prevalence in ‘COPD’? At best one in four Londoners with COPD are still smokers….

London Respiratory Team Smoking history distribution of a GP COPD List (n=111)

London Respiratory Team Smoking history distribution of a Tiotropium treated COPD List (n=52)

Improving the experience of all Londoners with COPD and minimising the impact of the disease London Respiratory Team League Table Anxiety Performance - LMC Being open and supportive Motivating presentation of data Shifting resources Using revalidation

Improving the experience of all Londoners with COPD and minimising the impact of the disease London Respiratory Team Consortia need help to measure primary care outcomes in COPD Annual prevalence of current smoking in COPD register % offered evidence based Stop smoking therapy % MRC 3 who were referred / completed PR % MRC score 3 or more with Pulsoximetry result Patient satisfaction of COPD care Consortia costs/per practice costs Admissions per practice