Type of publication:
*Ali A.; *Khan T.; *Ahmed J.; *Sesan A.; *Moudgil H.; *Makan A.; *Nawaid A.; *Ibrahim J.; *Crawford E.; *Srinivasan K.S.
American Journal of Respiratory and Critical Care Medicine; May 2019; vol. 199 (no. 9)
Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a disease state characterized by progressive airflow limitation that is not fully reversible. It encompasses chronic bronchitis and emphysema. This condition is both treatable and preventable. The incidence of COPD in the UK is estimated to be 3 million out of which 900,000 are diagnosed and 2 million remain undiagnosed. Acute exacerbation of COPD is one of the most common causes of emergency hospital admissions with 115,000 admissions per year with a mortality rate of 12 deaths during hospital stay and 6 dying within 90 days of admission.1&2 In the current state of increased healthcare costs related to hospital admissions, there is a service need to manage patients with long-term conditions in the community through development of specialist teams. The multidisciplinary community team consists of specialist nurses, doctors, therapists and community matrons who deliver services through community clinics, domiciliary visits, pulmonary rehabilitation and MDT meetings. Studies have shown the benefits of promoting self-management and providing care closer to home in terms of reducing unnecessary primary care contacts as well as hospital admissions; thereby reducing mortality . Aim The primary aim was to evaluate the role of MDT in reducing or preventing hospital admissions and secondary aim was to look at overall mortality in this cohort. Method(s): This was a retrospective study looking at the clinical notes and MDT letters for all patients with COPD (with post bronchodilator FEV1 of <70%) discussed in a local MDT meeting at a District General Hospital in the UK. Data on mortality and hospital admissions was obtained from our Clinical Portal, which is an electronic patient information system. Result(s): 151 patients were discussed at the local MDT meeting. 55.6% of females (graph 1) with a mean age of 72 years. After discussion at MDT, the number of hospital admissions were either reduced or remained the same in 65% (n= 98) but only 28% (n=42) of patients had more admissions. Data was not available for 9 patients. 64% (n=96) patients are alive 3 years from the discussion at the MDT meeting. Conclusion(s): Our study suggests that, the approach of community based MDT management of patients with COPD has got the advantage of reducing the healthcare expenditure on this cohort of patients, with no negative effect on mortality. As such, we propose these services to be funded in the near future.