Project Community Clinics

Transcription

1 Project Community Clinics Charlotte Beddow Respiratory Nurse University Hospitals Coventry & Warwickshire NHS Trust RIPPLE

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4 COPD Exacerbations & Survival 13.9% of people admitted with an exacerbation of COPD die within 90 days 25% of people admitted with an exacerbation of COPD die within 1 year >25,000 deaths/year in England & Wales 5% Deaths

5 0 Chronic obstructive pulmonary disease Implementing NICE guidance 3 rd. Edition - April 2012 NICE clinical guideline 101

6 High value ( right care ) approaches: COPD value pyramid Southwark Clinical Commissioning Group Lambeth Clinical Commissioning Group

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8 Symptoms Isolation Poor self management Anxiety & Depression Low self esteem

9 Symptoms Isolation Decreased Wellbeing Poor self management Anxiety & Depression Low self esteem

10 Symptoms Isolation Increased Use NHS Resources Poor self management Anxiety & Depression Low self esteem

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14 More than a set of broken lungs. Most have multiple co-morbidities.

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18 Narrative Landscape

19 RIPPLE: Respiratory Innovation Promoting a Positive Life Experience Facilitated by West Midlands Respiratory Improvement Programme Whole system approach Partnership local patients & carers, primary and secondary care clinicians, academics, public health professionals, and third sector organisations Develop innovative solutions to the social isolation and anxiety we had observed in individuals with COPD ABCD Model linking patients to existing community assets using an experienced local charity

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22 Located in a Community Centre Staffed by Third Sector, Volunteers, Medical Staff & Hospital Chaplaincy Team Informal fun activities Gentle exercise and mindfulness Self management support Individual clinical support when required

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25 The integration of health care and social activities has delivered transformational change in peoples lives Reduced social isolation Reduced anxiety Increased mental wellbeing Improved confidence in ability to self-manage Peer to peer education & support groups have evolved Preliminary evidence of a reduction in unplanned admissions

26 How socially included do you feel? How aware are you of any other services/ organisations that can help you? How well do you understand what COPD is? How well do you feel you use your inhaler? How well do you understand how your medication works? How confident do you feel to manage your own condition? Series Pre Post Ripple Series1

27 60 55 Age Matched Controls 50 RIPPLE Pre Ripple 3 Months N=31 6 Months N=15

28 Cohort Patients regularly attending RIPPLE (n=31) Similar patients not attending RIPPLE (n=41) Number Unscheduled Admissions Feb-Jul Number Uncsheduled Admissions Feb-Jul 15

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35 Innovation requires an element of risk-taking, time and perseverance. NHS organisational procedures optimised in hospitals are not always well suited to a community holistic care model. Responsive project management can be difficult within NHS reporting/governance structures. There are cultural and organisational differences between the NHS and third sector, but they can be overcome. Some individuals have found our approach challenging. It is essential to obtain the support of senior management at an early stage.

36 Negotiating ongoing funding from CCG Nurturing self support groups Integrating formal clinical appointments/reviews Pilot for other LTC management One stop multiple co-morbidity service Moving towards patient centered holistic care, with realistic goal setting and reduced polypharmacy

37 We have defined a new model of care, we now need to test transferability, efficacy and value for money Further funding from Health Foundation for spread to 5 centres in West & East Midlands Additional funding from West Midlands Strategic Clinical network for an extra site in West Midlands Working towards a NIHR bid with Coventry University

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