Chronic Obstructive Pulmonary Disease Research Opportunity

Chronic Obstructive Pulmonary Disease (COPD)

Dr Ian WilliamsGreater Metro South Brisbane Medicare Local

Chronic Obstructive Pulmonary Disease Research Opportunity

Aim of presentation

Setting the scene12

3 Suggested research project

Early results of literature review

Chronic Obstructive Pulmonary Disease Research Opportunity

For the last 20 years, COPD rates have remained unchanged for hospital

admissions …

Why?

Chronic Obstructive Pulmonary Disease Research Opportunity

Chronic disease in GMSBML

Greater Metro South Brisbane ML population = 915, 859

20% of the Queensland population

11.2% aged 65 years and over

3.4% diagnosed with Type 2 Diabetes

26.5% with Respiratory system disorders

15.5% with Circulatory system diseases

11.8% with Psychological distress

Chronic disease statistics

Chronic Obstructive Pulmonary Disease Research Opportunity

In 2013, it is estimated that there are ~ 29,000 symptomatic COPD patients in GMSBML region.

Less than 50 per cent of symptomatic patients are currently diagnosed and managed.

There are another 27,000 patients with early stage, asymptomatic COPD.

Source: Boehringer Ingelheim, Data on COPD and Asthma nationally and in the Greater Metro South Brisbane Medicare Local, 2013

The scene …

Chronic Obstructive Pulmonary Disease Research Opportunity

Avoidable hospital admissions

8.9% (~ 8000) of all admissions could be managed in Primary Care

Male rate of hospitalisation ~ 38% higher than female

Avoidable presentation is category 4 or 5

4 semi-urgent such as a minor cut requiring sutures seen within 1 hour

5 medical condition which has been long standing and unchanging

Chronic Obstructive Pulmonary Disease Research Opportunity

Admissions – chronic conditions

51% (~ 4000) of potentially avoidable admissions are related to chronic conditions

25% with diabetes complications

20.3% with COPD

16.6% with Angina

15% with congestive heart failure

Chronic Obstructive Pulmonary Disease Research Opportunity

There is certainly a lack of evidence regarding the effectiveness of Chronic Care Model/Integrated Care Models in the primary care setting.

There is some evidence that supports implementation of an Integrated Care Model,

e.g. improvement in quality of life, functional exercise capacity, and more planned preventive-consultations have been shown in primary care.

Models of care for COPD in primary care

Chronic Obstructive Pulmonary Disease Research Opportunity

Research needed to determine the best way/s of managing COPD in Greater Metro South Brisbane region

In 2010-11, COPD ranked as the second highest chronic condition in the GMSBML region for potentially preventative patient episodes of care for chronic conditions in public hospitals1

1 Metro South Hospital and Health Service, 2012 COPD ED presentations, GMSBML region, Queensland Health

Chronic Obstructive Pulmonary Disease Research Opportunity

As an extension to the CCM, other (but very related) models have been developed as well:

Disease management programs or Integrated care models for COPD.

COPD models in generalA shift from an acute care to a chronic care approach:

Current models of care for COPD rely mainly on Wagner’s Chronic Care Model (CCM)

Chronic Obstructive Pulmonary Disease Research Opportunity

Chronic care model (CCM)

Components of CCM

Self-management

Delivery system design

Adams et al. (2007) showed that patients with COPD who received

interventions with 2 or more CCM components had lower rates of

hospitalizations and emergency or unscheduled visits and a shorter

length of stay compared with control groups .

Decision support

Clinical information system

Chronic Obstructive Pulmonary Disease Research Opportunity

More evidence …

There is certainly a lack of evidence regarding the effectiveness of CCM/Integrated Care Models in the primary care setting

There is some evidence that supports implementation of an Integrated Care Model:

The Cochrane review on Integrated Disease Management (IDM showed in a subgroup analysis (primary care studies) a clinically relevant and statistically significant difference in quality of life and functional exercise capacity of in favour of IDM.

The same authors recently published a protocol of an intervention study on the cost-effectiveness of an IDM for COPD in primary care, as there is no evidence yet.

Chronic Obstructive Pulmonary Disease Research Opportunity

Bourbeau et al. (2013):

Increasing number of studies on Integrated Care show positive outcomes for patients with COPD.

These studies have in common a self-management intervention including an action plan

In a narrative review on the Integrated Care Model in primary care, Bourbeau et al. highlight several relevant themes

Education alone is not enough: a self-management programme should aim at behaviour change

Self-management will not suit all patients.

Self-management programme in primary care does not have a great uptake yet

Chronic Obstructive Pulmonary Disease Research Opportunity

Bourbeau et al. (2013): Recently published trials have brought controversy with respect to the effectiveness of self-management programmes, especially in patients with high burden of disease and co-morbidities.

It may be more challenging to make the patient with high burden of disease a partner and not without risk of serious adverse events.

Bourbeau et al. propose an integrated care model with stratification according to disease severity.

Chronic Obstructive Pulmonary Disease Research Opportunity

Research proposal

1

2

3

Partner with a local University with a view toSystematic review of the literature regarding models of care for COPD patients in the primary care setting.

Investigate current models being used in GMSBML Mixed methods: Social Network Analysis

How does this compare to phase 1

Trial proposed models of care in GMSBMLInformed by phase 1 and 2Guided by implementation scienceSustainability

Chronic Obstructive Pulmonary Disease Research Opportunity

Thank You