Chronic Obstructive
Pulmonary Disease (COPD)
Dr Ian Williams
Greater Metro South Brisbane Medicare Local
Chronic Obstructive Pulmonary Disease
Research Opportunity
Aim of presentation
1 Setting the scene
Early results of literature review
2
3
Suggested research project
Chronic Obstructive Pulmonary Disease
Research Opportunity
For the last 20 years, COPD rates
have remained unchanged for
hospital admissions …
Why?
Chronic Obstructive Pulmonary Disease
Research Opportunity
Chronic disease in GMSBML
Greater Metro South Brisbane ML population = 915, 859
20% of the Queensland population
11.2% aged 65 years and over
Chronic disease statistics
3.4% diagnosed with Type 2 Diabetes
26.5% with Respiratory system disorders
15.5% with Circulatory system diseases
11.8% with Psychological distress
Chronic Obstructive Pulmonary Disease
Research Opportunity
The scene …
In 2013, it is estimated that there are ~ 29,000
symptomatic COPD patients in GMSBML
region.
Less than 50 per cent of symptomatic patients
are currently diagnosed and managed.
There are another 27,000 patients with early
stage, asymptomatic COPD.
Source: Boehringer Ingelheim, Data on COPD and Asthma nationally and in the Greater Metro South Brisbane Medicare Local, 2013
Chronic Obstructive Pulmonary Disease
Research Opportunity
Avoidable hospital admissions
8.9% (~ 8000) of all admissions could be managed in
Primary Care
Male rate of hospitalisation ~ 38% higher than female
Avoidable presentation is category 4 or 5
4 semi-urgent such as a minor cut requiring
sutures seen within 1 hour
5 medical condition which has been long
standing and unchanging
Chronic Obstructive Pulmonary Disease
Research Opportunity
Admissions – chronic conditions
51% (~ 4000) of potentially avoidable admissions are
related to chronic conditions
25% with diabetes complications
20.3% with COPD
16.6% with Angina
15% with congestive heart failure
Chronic Obstructive Pulmonary Disease
Research Opportunity
Models of care for COPD in
primary care
There is certainly a lack of evidence regarding the
effectiveness of Chronic Care Model/Integrated Care Models
in the primary care setting.
There is some evidence that supports implementation of an
Integrated Care Model,
e.g. improvement in quality of life, functional exercise
capacity, and more planned preventive-consultations have
been shown in primary care.
Chronic Obstructive Pulmonary Disease
Research Opportunity
Research needed to determine the
best way/s of managing COPD in
Greater Metro South Brisbane region
In 2010-11, COPD ranked as the second highest
chronic condition in the GMSBML region for potentially
preventative patient episodes of care for chronic
conditions in public hospitals1
1 Metro South Hospital and Health Service, 2012 COPD ED presentations, GMSBML region, Queensland Health
Chronic Obstructive Pulmonary Disease
Research Opportunity
COPD models in general
A shift from an acute care to a chronic care approach:
Current models of care for COPD rely mainly on
Wagner’s Chronic Care Model (CCM)
As an extension to the CCM, other (but
very related) models have been
developed as well:
Disease management programs or
Integrated care models for COPD.
Chronic Obstructive Pulmonary Disease
Research Opportunity
Chronic care model (CCM)
Components of CCM
Self-management
Decision support
Delivery system design
Clinical information system
 Adams et al. (2007) showed that patients with COPD who received
interventions with 2 or more CCM components had lower rates of
hospitalizations and emergency or unscheduled visits and a shorter
length of stay compared with control groups .
Chronic Obstructive Pulmonary Disease
Research Opportunity
More evidence …
There is certainly a lack of evidence regarding the effectiveness of
CCM/Integrated Care Models in the primary care setting
There is some evidence that supports implementation of an
Integrated Care Model:
The Cochrane review on Integrated Disease Management (IDM showed
in a subgroup analysis (primary care studies) a clinically relevant and
statistically significant difference in quality of life and functional exercise
capacity of in favour of IDM.
The same authors recently published a protocol of an intervention study
on the cost-effectiveness of an IDM for COPD in primary care, as there
is no evidence yet.
Chronic Obstructive Pulmonary Disease
Research Opportunity
Bourbeau et al. (2013):
In a narrative review on the Integrated Care Model in primary
care, Bourbeau et al. highlight several relevant themes
Increasing number of studies on Integrated Care show positive
outcomes for patients with COPD.
These studies have in common a self-management intervention
including an action plan
Education alone is not enough: a self-management programme should
aim at behaviour change
Self-management will not suit all patients.
Self-management programme in primary care does not have a great
uptake yet
Chronic Obstructive Pulmonary Disease
Research Opportunity
Bourbeau et al. (2013):
Recently published trials have brought controversy with
respect to the effectiveness of self-management programmes,
especially in patients with high burden of disease and comorbidities.
It may be more challenging to make the patient with high
burden of disease a partner and not without risk of serious
adverse events.
Bourbeau et al. propose an integrated care model with
stratification according to disease severity.
Chronic Obstructive Pulmonary Disease
Research Opportunity
Research proposal
Partner with a local University with a view to
1
Systematic review of the literature regarding models
of care for COPD patients in the primary care setting.
2
Investigate current models being used in GMSBML
3
Trial proposed models of care in GMSBML
Mixed methods: Social Network Analysis
How does this compare to phase 1
Informed by phase 1 and 2
Guided by implementation science
Sustainability
Chronic Obstructive Pulmonary Disease
Research Opportunity
Thank You
Chronic Obstructive Pulmonary Disease
Research Opportunity