The Implementation of a Copd Continuous Managment Improvment Programme; Learning for the Future

The implementation of a COPD continuous

management improvement programme:

learning for the future

Dear Sirs,

Adherence to recommended standards of management (such as NICE

guidelines in the UK) differs widely in clinical practice. Programmes of

management appear to drive improved patient outcomes, and there

have been several reports in this journal recently of the benefits that

follow formalised COPD disease management programmes.1-3 In the

most recent paper by Zakrission et al. in the December 2011 issue,3 there

was a significant reduction in exacerbation frequency in those patients

in the intervention group.

We therefore wish to report the findings of an audit and targeted

education programme on the management of COPD patients in

Dartford, Gravesham and Swanley (DG&S) in West Kent, UK, focussed

on the 2004 UK COPD NICE guidelines.4 A proprietary general practice

data audit tool (POINTS) (identical to the tool used by Roberts et al.2

previously) was integrated into 30 practices, and data were collected

from patients on the COPD registers. An education programme was

incorporated to underpin the launch and implementation of the

programme, and there were additional COPD clinic hours provided. The

programme also incorporated qualitative interviews with practice

members to determine attitudes and to learn from the process.

The programme was successful in improving the management of

COPD patients in DG&S according to NICE guidelines over a 12-month

period. Key improvements included statistically significant improvements

to the categorisation of patients by COPD severity (42% up to 60%;

p<0.001) and the recording of patient-centric measures (FVC,

exacerbations, and MRC dyspnoea scores; p<0.001. Inhaler technique

measurement; p<0.01).

The level of participation in the education programme and the

number of additional clinic hours appeared to drive improved interest,

knowledge and care of patients with COPD. Practices...