Executive Summary

Reducing the number of emergency admissions due to sub-optimal or undiagnosed COPD represents a key area of focus for the Hallam and South Consortium and, in 2010, it embarked upon a project with AstraZeneca to tackle the problem.

Through working with local COPD condition management stakeholders, and identifying appropriate interventions that could be delivered by practices, HASC reduced hospital admissions by over 10%, achieved significant improvements in key chronic condition management scores (FEV1, self-management plan awareness and MRC dyspnoea) and saw 98% of survey respondents report improved satisfaction with their assessments and a greater understanding of their condition and the medicines used to treat it.i

AstraZeneca and Working with the NHS Improving patient lives is at the heart of AstraZeneca’s business. In the UK, the primary customer for our medicines and consequent partner in helping us achieving that goal, is the NHS.

The ambitions of the NHS are broad and wide ranging, and it faces many challenges in achieving all it wants for people across the UK. As a result, NHS organisations are increasingly calling on external expertise to help them to meet these challenges.

AstraZeneca is committed to working in collaboration with the NHS as a means of supporting them to achieve more for patients, and welcomes the opportunity to provide the resource to support patient-centered projects.

Situation COPD is the second most common cause of emergency admissions to hospital and the most costly inpatient condition treated by the NHSii. It has been estimated that one in eight people over 35 in the UK has COPD which has not been properly diagnosed and over 15% are only diagnosed when they present to hospital as an emergencyii. Reducing the number of emergency admissions due to poorly managed or undiagnosed COPD represented a key area of focus for HASC, in line with the National Outcomes Strategy for COPD.

HASC recognised that, across Sheffield, there was a significant variation in the prevalence of patients with COPD (ranging from 0.5% to 4.4%)iii. In 2009, 9,484 patients were on the COPD register, but estimates from the British Lung Foundation suggests that many COPD patients remain undiagnosediv. An audit of lung-function tests revealed that 34%-100% of patients did not receive a timely testiii. Given that a better alignment with NICE COPD guidelines almost certainly would lead to reduced hospital admissions and improved management in primary care, HASC entered into a collaboration with AstraZeneca to tackle the problem.

AstraZeneca Joint Working Case Study Improving COPD Patients Outcomes in Collaboration with Hallam and South Consortium (HASC), a locality within Sheffield CCG

Date of Preparation: May 2013 Atlas ID: 2427004

Project Objective

• To reduce the number of inappropriate admissions to hospital due to COPD through timely and early intervention among patients with mild-moderate disease

Project Strategies

• Work with Public Health Development Nurses, Community Specialist Nurses, Practice Nurses and AstraZeneca Nurse Specialists to understand the benefits of collaborating more closely on COPD management

• Identify feasible and effective condition management interventions that could be delivered across the consortium’s primary care practices, and provide the education and support required to patients and primary care clinicians

Working Together in Practice

• Alignment with national health directives: All project elements were aligned with the National Outcomes Strategy for COPD

• Patient selection: MOSAIC data was used to engage practices who fed into the ‘High Risk, High Admissions’ sector. AstraZeneca provided COPD Navigator/OSKIS software to help identify and prioritise ‘at-risk’ patients for involvement in the project

o ‘At-risk’ patients were identified as those who had gaps in clinical care and / or who were at risk of exacerbation or hospital admission

• Reviewing and assessing ‘at-risk’ patients: : Identified ‘at-risk’ patients were invited for a full clinical assessment – conducted by the practice nurses with support from a Public Health Development Nurse or an Ashfield In2Focus specialist nurse provided by AstraZeneca. The assessment included spirometry, inhaler technique, symptom control, self-management and sign-posting to community services including pulmonary rehabilitation and community COPD clinic

Key Outcomes

• 75% of consortium practices – 21 of 28 - participated in the initiativeiii

• A total of 1,571 patients were reviewed between April 2010 to March 2012iii

• A 10.6% (n = 303 to 271) reduction in hospital admissions was observed between (April 2010 - March 2012)iii

• There was significant improvement in the number of people with COPD who had a recorded FEV1 (29% - 40%, n=448/634), self-management plan (4%-18%, n=58/290) and MRC dyspnoea score (64%-70%, n=992/1097)iii

• There was a modest increase in the number of people with a recorded inhaler technique checked (53%-57%, n=823/899)iii

• In total, 658 patients were referred to the community pulmonary rehabilitation over the course of the projectiii

• Feedback was collected from 123 patients (7% of total population between January 2011 and November 2011)iv

o 100% of survey respondents stated that they were ‘completely satisfied’ or ‘satisfied’ with their consultation, including individual scores for listening to the patients’ worries, answering any questions and providing “specific and relevant” information

o 98% of survey respondents also stated that they understood their condition and medicines and treatments ‘much more’ or a ‘little more’ than before

‘This project, undertaken in collaboration with AstraZeneca, clearly demonstrated that the identification and proactive management of patients with mild-moderate COPD - in line with national frameworks, NICE COPD Guidelines, and the NICE Quality Standard - can help to reduce hospital admissions for people with COPD. Essential to this proactive, optimal management was the training and education practice staff received to ensure that nurses both were working in accordance with the current evidence-based guidelines and were delivering a consistent level of care across the consortium’s practices. The challenge for us now is to sustain these improvements.’ Andrew Booth Lead Primary Care Development Nurse, West and South Yorkshire and Bassetlaw Commissioning Support Unit

‘This was the first project undertaken between HASC and AstraZeneca, and the collaboration proved extremely valuable. The project’s steering committee concluded that it should be ‘used as an example of how working with the pharmaceutical industry can be successful’. Sue Nutbrown General Practice Nurse Partner, HASC Board Member and COPD Lead

References

i AstraZeneca Clinical Services Feedback HASC (Data on file)

ii An Outcomes Strategy for COPD and Asthma: NHS Companion Document (2012)

iii HASC COPD Project Final Report (Data on file) 2011

iv British Lung Foundation. Invisible Lives. COPD – finding the missing millions. November 2007

Date of Preparation: May 2013 Atlas ID: 2427004