P29 Impact Of Respiratory Virtual Clinics In Primary Care On Responsible Respiratory Prescribing And Inhaled Corticosteroid Withdrawal In Patients With Copd: A Feasibility Study

Abstract

Outcomes COPD Assist was launched in March 2014, then publicised to all Salford's primary care clinicians supported by 5 training seminars with over 70 clinicians attending.Within 4 months following its launch, COPD assist was downloaded 622 times by different users, with an average use time of 7 min and average of 9 screens viewed per session. 52% of users have used the app more than once.Feedback was excellent, particularly around ease of use and simplicity. Conclusions This bespoke smartphone app to support the implementation of local primary care COPD guidelines appears to be widely acceptable to users and could potentially promote these guidelines. However, more research around clinically meaningful outcomes, such as adherence to guidelines and impact on prescribing, is required to assess the true impact of such technology on the management of COPD in primary care. P29IMPACT Introduction There is considerable variation in accuracy of diagnosis and long-term management of COPD in the UK. High rates of inhaled corticosteroid (ICS) prescribing have been reported, raising concerns about their over use, with less focus on high value interventions like stop smoking support/pulmonary rehabilitation. ICS are indicated in severe COPD patients (FEV 1 <50% predicted) with frequent exacerbations (>2 per year). Primary care data from SE London showed that 38% of COPD patients were over treated with high dose ICS, resulting in 12 additional cases of pneumonia, and costs >£500,000, annually. There is limited guidance on methods and feasibility of withdrawing ICS in these patients. Methods A responsible respiratory prescribing group including CCG medicines management, respiratory pharmacist and integrated respiratory team agreed COPD prescribing guidance across primary/ secondary care. GPs were supported with COPD review templates, written step down protocols and educational events. Virtual clinics with an integrated respiratory consultant/ GP respiratory lead were offered to support ICS withdrawal in primary care.

Reducing the use of inhaled corticosteroids in mild-moderate COPD: an observational study in east London

“…The intervention components included: A brief clinical guideline developed through the CCG COPD working group in collaboration with local stakeholders from primary care, consultant respiratory physicians from the local hospital NHS trust and the Tower Hamlets Public Health team. The guidance was based on clinical evidence and programmes successfully undertaken elsewhere 21 , and included an algorithm to support clinical decision making (see Fig. 2 ) based on the risk assessment model from GOLD.…”

“…Systematic programmes to achieve ICS reduction have been undertaken in other parts of the United Kingdom, overseen by respiratory consultants running virtual clinics in general practice 21 . The aim of this study is to evaluate a quality improvement programme to reduce ICS prescribing in primary care in east London.…”

The role of the clinical pharmacist in the respiratory or sleep multidisciplinary team

“…Integrated respiratory care requires insight into care delivery across the hospital and primary care settings. Increasingly, pharmacists are adopting roles that see them embedded in secondary care teams and general practice [33][34][35], delivering expert care and intervention to people with airways disease and complex pharmaceutical needs. These could be patients with adherence issues or polypharmacy, or those taking medicines that require monitoring or careful counselling prior to initiation, e.g.…”