System of Shared Care - COPD
Prototype Session 2
Westin Wall Centre Hotel
June 16, 2011
Learning from each other:
Changes in action
Team report out
Christina Southey
Team Kelowna
Team Kelowna
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Dr. Phillip White
Mary Anne Sarin (MOA)
Laurie Sinclair M.Ed.
Todd Gale (RT)
Reed Scott (PSP)
Zahra Hussein (PSP)
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Background information
Dr. Phillip White
(Rutland Medical)
• 2500 FP patients
• 125 COPD patients
(5%)
Todd Gale (RT)
• COK Section Head
for RT
• Scope includes
COPD, Primary
Care…etc
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Our team aim
We aim to improve COPD case finding using the
COPD-6 Spirometer with 25 patients by June 4, 2011.
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Changes
• Case finding approach using COPD-6 with 25
patients
• Utilized NP/MOA to assist GP in COPD-6
screening
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Our measures
Dr. White’s Results
• Among 25 patients trialed/screened with COPD-6:
 12 (48%) did not meet criteria for Spirometry testing
referral
 13 (52%) did meet criteria and were sent to Pulmonary
Lab for Spirometry testing
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Our measures
Todd Gale’s (RT) Results
Spirometer
COPD 6
FEV1
FEV1 % pred
FVC
FEV1/FVC
Result
GOLD Class
4.91
111%
6.32
0.78
Normal
Normal
3.31
88%
4.13
0.8
Normal
Normal
2.87
75%
4.63
0.62
Mild
Stage 2
1.69
66%
3.91
0.66
Mild
Stage 2
1.47
79%
2.26
0.65
Mild
Stage1
4.07
91%
5.48
0.74
Normal
Normal
1.84
88%
2.41
0.76
Normal
Normal
2.47
68%
4.11
0.6
Mild
Stage 2
0.96
61%
1.49
0.64
Mild
Stage 2
Test:
Performed 11 COPD-6 +
Spirometry tests on the
same 11 patients to check
for correlation
Result:
Good correlation…pretty
good tool!
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Patient story
Jerry’s story
(By Laurie and Dr. White)
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Recommendations
Recommendations for next test cycle
• Things we would do again
 Continue use of COPD-6 for screening
 Support NP and MOA to conduct COPD-6 screening
• Things we suggest not to do
 None… just try it !
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Summary of current status
• Successes:
 Great screening device
 MOA/RN/NP can assist GP in COPD screening
• Challenges and/or barriers:
 COPD-6 can be time consuming (2-3 attempts)
 IHA Pulmonary Function Lab capacity for Spirometry
referrals
• What we are planning to test next:
 Utilize NP Clinic to conduct COPD screening
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Cranbrook and Kimberley’s
changes in action
Interior Health
Our team
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Cranbrook and Kimberley, East Kootenay
• Rural full service family practice
• Group practice
• 25.2% of East Kootenay males
smoke
• High prevalence of COPD
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Our team aim
We aim to improve early detection of COPD in our
practices using the COPD-6 so that all patients who
are seen in the office who smoke or are over 40
with a cough will be screened by June 16, 2011.
The COPD-6 will also be tested for its usefulness in
family practice on 20 patients (per GP).
We also aim to increase awareness and education
to GPs and patients about COPD and services
available.
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Tests of change – Case finding
• Lung Health Questionnaire
• COPD-6
• MOA
• Routine physical
• Health Fair
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Tests of change – Smoking cessation
• Using lung age on COPD-6
• Referring to Quit Now
• In office counseling
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Patient story
• 28 year old 2 pack per day smoker since the age
of 12
• Lung age 82 years old
• Quit smoking
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Tests of change – Patient education
• Recall/Follow up
• Working with respiratory
therapist
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Tests of change – Specialist referrals
• Inform GPs of Internal Medicine support for
COPD clients
• Remind GPs of referral criteria
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Our measures
COPD-6 device:
 45 patients in GP office
 20 patients by RT
Smoking cessation:
 11 patients quit smoking (1 relapse)
 1 patient quit marijuana
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Provider experience
• Review of guidelines
• More aware of screening and early detection of
COPD
• Increased confidence providing smoking
cessation support
• COPD-6 lung age creates an opportunity to break
down barriers and provides an “in”
• Surprised by number of colleagues patients who
are not receiving guideline based care
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Challenges
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Fee code
Time
MOA buy in
GP colleague buy in
RT capacity
Internal Medicine capacity
Patients tend to respond better to GPs than
others
• Coordinating with other programs (GSK)
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What we will do next
• Meeting planned for September with GP
community
• Continue to build registry and screen all smokers
over 40
• Set up recall system for COPD
 Aim for 2 visits/year
• Advanced Care Planning
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Questions?
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Team VIHA
Dr. Frank Egan
What did I try/do?
• I completed 60 COPD-6 tests ..found a way to
make them fit into my daily routine for assessing
my patients. 15% were positive - for COPD - 1/3
unexpected
• Developed an emr button to record score for obs
index and COPD-stage
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What did I do?
• Had several team meetings to develop an
“optional” Respiratory Referral Form.
• Introduced the COPD-6 screening device to 3
colleagues and set them up to start COPD
screening.
• Recruited a patient for COPD patient mapping
and attended an afternoon mapping session.
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COPD-6 (patient selection )
• Smokers and ex-smokers
• Puffers
• Unexplained shortness of breath
(SOB)
• History of pneumonia/lung injury
• During full physicals
• Group visit for diabetes –did 12 COPD-6
(3 positive -2 unexpected-)
Think of it like blood pressure for cardiac
assessment ..lung age for Respiratory
assessment.
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What is COPD?
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The COPD-6 report
• Sign ,show and state (3S) the meaning of the report
• Flip to the Blank Side and ............S.T.A.R.T.
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S.
T.
A.
R.
T.
Set date
Tell (support people)
Avoid (triggers)
Relapse plan - go to S.What to take ...NRT, Champix, Zyban, etc
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Copd-6 screening results
COPD-6 office demo
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Quit quitting video
Dr. Derek Poteryko
Lunch