Chronic obstructive pulmonary disease (COPD) exacerbations impose a major burden on the NHS with patients often being treated with antibiotics and steroids, despite a large proportion of patients being viral-induced or non-infective.
Dr Roy, along with community respiratory nurses and the psychology team at the University of Hertfordshire, conducted a collaborative study with an integrative approach to care. The team investigated whether incorporation of home-based respiratory point-of-care testing (R-POCTc) for COPD would reduce antibiotic prescribing, help to avoid hospital admission and improve patient experiences and quality of life (QoL).
Forty-two GOLD stage C/D* COPD patients reported their exacerbation symptoms by telephone and nurses visited them to take nasopharyngeal swabs for testing† back at the community hub. Patient-reported experience measures (PREMs), health anxiety and QoL questionnaires were also collected and outcomes were compared before and after the implementation of R-POCTc.
R-POCTc allowed antibiotics to be withheld in 32 patients who would have received this treatment at their previous exacerbation and a significant number of patients avoided hospital admission. Quality of life was also found to be significantly higher after service implementation (mean difference -2.2, p=0.002).
Overall it was found that R-POCTc improved quality of care in severe COPD by delivering a safe, personalised approach, enhancing the patient experience and journey. It is hoped that this could help mediate the high levels of anxiety found in this patient group, which is thought to precipitate exacerbations.
Dr Roy is looking to see how widely the hospital-at-home service could be integrated into respiratory care systems in other geographical areas, to improve COPD patient wellbeing.
Dr Kay Roy is a consultant in respiratory and general medicine at West Hertfordshire NHS Trust, Hemel Hempstead, UK
*Patients were characterised as COPD GOLD stage C/D if they exhibited Medical Research Council dyspnoea questionnaire (MRC) scores of 3, a mean forced expiratory volume in one second (FEV1) < 50% predicted, with a mean of 4 exacerbations and 1 hospitalisation in the last year.
†Patients were tested for the presence of 12 respiratory viruses as well as 4 atypical bacteria and levels of serum inflammatory markers, C-reactive protein (CRP) and procalcitonin (PCT) were assessed.
This project was initiated and funded by Teva Respiratory. Teva have had no influence over content. Topics and content have been selected and written by independent experts.
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