Impact of a community respiratory assessment service on evidence based prescribing in primary care

I.S. Patel, H. Milestone, S. Dawson, L. Killean, K. Bertenshaw, R. Haffenden, N.R. Roberts, M.R. Partridge

    Research output: Contribution to journalMeeting abstract

    Abstract

    Introduction: The Community Respiratory Assessment Unit (CRAU) in Hammersmith and Fulham provides open-access nurse-led spirometry and evidence-based disease management support to primary care.

    Methods: The primary care records of 100 patients referred from March 2008 to April 2009 (51M/49F, mean age 61 years, 77 current/ex-smokers) were examined to quantify whether suggestions made in the CRAU had been translated into practice.

    Results: In 32 patients no treatment change was recommended as they were already on optimal management (18 mild COPD, 8 moderate COPD, 1 severe COPD and 5 with asthma). No therapeutic changes were recommended in a further 10 with a restrictive defect and in 21 with normal spirometry. Of the 37 patients in whom a change in treatment was suggested, 29 (78%) had COPD (16M/13F, mean age 71 years, 21 current smokers, 17 mild, 8 moderate, 4 severe disease), 7 had asthma (4M/3F, mean age 39.7 years, 3 current smokers) and 1 had normal spirometry. The referring GP adopted suggested changes fully in 18 patients (49%) and partially in 5 (13%). In 14 patients (38%) the recommended alterations were not made. The range of suggested alterations of pharmacotherapy and rates of implementation in primary care are shown in table 1. In 6/18 (30%) cases where inhaled corticosteroids (ICS) or a combination of a long-acting ß agonist with ICS were recommended, this was not adopted. In 8/14 (57%) cases where tiotropium was recommended, this was not adopted.
    Original languageEnglish
    Article numberP46
    JournalThorax
    Volume64
    Issue numberIssue Suppl 4
    Publication statusPublished - Dec 2009

    Fingerprint

    Primary Health Care
    Chronic Obstructive Pulmonary Disease
    Spirometry
    Adrenal Cortex Hormones
    Asthma
    Disease Management
    Therapeutics
    Nurses
    Drug Therapy

    Keywords

    • community respiratory assessment service
    • community respiratory assessment unit
    • CRAU
    • primary care
    • evidence based prescribing
    • prescribing

    Cite this

    Patel, I. S., Milestone, H., Dawson, S., Killean, L., Bertenshaw, K., Haffenden, R., ... Partridge, M. R. (2009). Impact of a community respiratory assessment service on evidence based prescribing in primary care. Thorax, 64(Issue Suppl 4), [P46].
    Patel, I.S. ; Milestone, H. ; Dawson, S. ; Killean, L. ; Bertenshaw, K. ; Haffenden, R. ; Roberts, N.R. ; Partridge, M.R. / Impact of a community respiratory assessment service on evidence based prescribing in primary care. In: Thorax. 2009 ; Vol. 64, No. Issue Suppl 4.
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    abstract = "Introduction: The Community Respiratory Assessment Unit (CRAU) in Hammersmith and Fulham provides open-access nurse-led spirometry and evidence-based disease management support to primary care.Methods: The primary care records of 100 patients referred from March 2008 to April 2009 (51M/49F, mean age 61 years, 77 current/ex-smokers) were examined to quantify whether suggestions made in the CRAU had been translated into practice.Results: In 32 patients no treatment change was recommended as they were already on optimal management (18 mild COPD, 8 moderate COPD, 1 severe COPD and 5 with asthma). No therapeutic changes were recommended in a further 10 with a restrictive defect and in 21 with normal spirometry. Of the 37 patients in whom a change in treatment was suggested, 29 (78{\%}) had COPD (16M/13F, mean age 71 years, 21 current smokers, 17 mild, 8 moderate, 4 severe disease), 7 had asthma (4M/3F, mean age 39.7 years, 3 current smokers) and 1 had normal spirometry. The referring GP adopted suggested changes fully in 18 patients (49{\%}) and partially in 5 (13{\%}). In 14 patients (38{\%}) the recommended alterations were not made. The range of suggested alterations of pharmacotherapy and rates of implementation in primary care are shown in table 1. In 6/18 (30{\%}) cases where inhaled corticosteroids (ICS) or a combination of a long-acting {\ss} agonist with ICS were recommended, this was not adopted. In 8/14 (57{\%}) cases where tiotropium was recommended, this was not adopted.",
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    author = "I.S. Patel and H. Milestone and S. Dawson and L. Killean and K. Bertenshaw and R. Haffenden and N.R. Roberts and M.R. Partridge",
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    Patel, IS, Milestone, H, Dawson, S, Killean, L, Bertenshaw, K, Haffenden, R, Roberts, NR & Partridge, MR 2009, 'Impact of a community respiratory assessment service on evidence based prescribing in primary care', Thorax, vol. 64, no. Issue Suppl 4, P46.

    Impact of a community respiratory assessment service on evidence based prescribing in primary care. / Patel, I.S.; Milestone, H.; Dawson, S.; Killean, L.; Bertenshaw, K.; Haffenden, R.; Roberts, N.R.; Partridge, M.R.

    In: Thorax, Vol. 64, No. Issue Suppl 4, P46, 12.2009.

    Research output: Contribution to journalMeeting abstract

    TY - JOUR

    T1 - Impact of a community respiratory assessment service on evidence based prescribing in primary care

    AU - Patel, I.S.

    AU - Milestone, H.

    AU - Dawson, S.

    AU - Killean, L.

    AU - Bertenshaw, K.

    AU - Haffenden, R.

    AU - Roberts, N.R.

    AU - Partridge, M.R.

    PY - 2009/12

    Y1 - 2009/12

    N2 - Introduction: The Community Respiratory Assessment Unit (CRAU) in Hammersmith and Fulham provides open-access nurse-led spirometry and evidence-based disease management support to primary care.Methods: The primary care records of 100 patients referred from March 2008 to April 2009 (51M/49F, mean age 61 years, 77 current/ex-smokers) were examined to quantify whether suggestions made in the CRAU had been translated into practice.Results: In 32 patients no treatment change was recommended as they were already on optimal management (18 mild COPD, 8 moderate COPD, 1 severe COPD and 5 with asthma). No therapeutic changes were recommended in a further 10 with a restrictive defect and in 21 with normal spirometry. Of the 37 patients in whom a change in treatment was suggested, 29 (78%) had COPD (16M/13F, mean age 71 years, 21 current smokers, 17 mild, 8 moderate, 4 severe disease), 7 had asthma (4M/3F, mean age 39.7 years, 3 current smokers) and 1 had normal spirometry. The referring GP adopted suggested changes fully in 18 patients (49%) and partially in 5 (13%). In 14 patients (38%) the recommended alterations were not made. The range of suggested alterations of pharmacotherapy and rates of implementation in primary care are shown in table 1. In 6/18 (30%) cases where inhaled corticosteroids (ICS) or a combination of a long-acting ß agonist with ICS were recommended, this was not adopted. In 8/14 (57%) cases where tiotropium was recommended, this was not adopted.

    AB - Introduction: The Community Respiratory Assessment Unit (CRAU) in Hammersmith and Fulham provides open-access nurse-led spirometry and evidence-based disease management support to primary care.Methods: The primary care records of 100 patients referred from March 2008 to April 2009 (51M/49F, mean age 61 years, 77 current/ex-smokers) were examined to quantify whether suggestions made in the CRAU had been translated into practice.Results: In 32 patients no treatment change was recommended as they were already on optimal management (18 mild COPD, 8 moderate COPD, 1 severe COPD and 5 with asthma). No therapeutic changes were recommended in a further 10 with a restrictive defect and in 21 with normal spirometry. Of the 37 patients in whom a change in treatment was suggested, 29 (78%) had COPD (16M/13F, mean age 71 years, 21 current smokers, 17 mild, 8 moderate, 4 severe disease), 7 had asthma (4M/3F, mean age 39.7 years, 3 current smokers) and 1 had normal spirometry. The referring GP adopted suggested changes fully in 18 patients (49%) and partially in 5 (13%). In 14 patients (38%) the recommended alterations were not made. The range of suggested alterations of pharmacotherapy and rates of implementation in primary care are shown in table 1. In 6/18 (30%) cases where inhaled corticosteroids (ICS) or a combination of a long-acting ß agonist with ICS were recommended, this was not adopted. In 8/14 (57%) cases where tiotropium was recommended, this was not adopted.

    KW - community respiratory assessment service

    KW - community respiratory assessment unit

    KW - CRAU

    KW - primary care

    KW - evidence based prescribing

    KW - prescribing

    M3 - Meeting abstract

    VL - 64

    JO - Thorax

    JF - Thorax

    SN - 0040-6376

    IS - Issue Suppl 4

    M1 - P46

    ER -

    Patel IS, Milestone H, Dawson S, Killean L, Bertenshaw K, Haffenden R et al. Impact of a community respiratory assessment service on evidence based prescribing in primary care. Thorax. 2009 Dec;64(Issue Suppl 4). P46.