Breakout 4.2 Optimise not maximise for better value COPD and asthma care - Noel Baxter

Breakout 4.2 Optimise not maximise for better value COPD and asthma care - Noel Baxter

• 1.
  Optimise not maximisefor better value COPD & asthma care Noel Baxter GP Co-lead NHS London Respiratory Team The VALUE equation Health Outcomes Value Cost = Patient defined Health Outcomes bundle of care Cost of delivering Outcomes Porter ME; Lee TH NEJM 2010;363:2477-2481; 2481-2483 1
• 2.
  We know whatinterventions are good value – when they are done in the right way Triple Therapy £35,000- £187,000/QALY LABA £8,000/QALY Tiotropium £7,000/QALY Pulmonary Rehabilitation £2,000-8,000/QALY Stop Smoking Support with pharmacotherapy £2,000/QALY Flu vaccination £1,000/QALY in “at risk” population What works long term and is cost effective? A cost effective intervention in COPD - Stopping Smoking 1 year abstinence QALY % £ Usual care 1.4 Minimal counselling 2.6 14,735 Intensive counselling 6 7,149 Intensive counselling + 12.3 2,092 pharmacotherapy Systematic Review of 9 studies Hoogendoorn M, Feenstra TL, Hoogenveen RT, Rutten-van Mo¨lken MPMH. Thorax 2010: 65:711-718 2
• 3.
  The low valuepyramid We know how to allocate resource at population level http://www.impressresp.com/index.php?option=c om_content&view=article&id=167:impressions-28- relative-value-of-copd- interventions&catid=11:impressions&Itemid=3 3
• 4.
  COPD in London:What do we know? Londoners dying from smoking ‘1 in 5 deaths due to smoking’ 4
• 5.
  Stop smoking support:Step 1 treatment for people with asthma who smoke and for households of children with asthma that smoke “ 32.5% of patients admitted to hospital were current smokers …a further 18.8% were ex‐smokers …a significantly greater number of asthmatics reported themselves to be smokers over the general population … … smoking causes steroid resistance in asthma and is associated with other ‘risk’ behaviours, which may make this group more likely to be admitted to hospital Optimal healthcare for up to 1:4 people with a long term condition is stop smoking support as treatment 5
• 6.
  Admissions ( asthmaand COPD) : What factors can we influence as health professionals ? • Bed capacity • Distance to hospital • Deprivation of population • Socioeconomic status • Prevalence of COPD • Prevalence of smoking in our practices Where can we make an impact for people with COPD and asthma ? • For every 1% increase in prevalence of smoking in your COPD population there is a 1% increase in COPD admission rates. • For every 1% increase in prevalence of smoking in your asthma population there is a 1% increase in asthma admission rates. 6
• 7.
  7
• 8.
  PCT monthly COPDdashboard 2013 Prevalence of current smoking where status 1550/3335 = 46.5% recorded in last 15 months COPD smokers in last year receiving evidence based stop smoking support – 17.5% Quit smoking as treatment Sharing Whittington learning Health professionals esp doctors need to believe quit smoking interventions are part of their role & responsibility Behaviour change: importance, confidence Make it easy to do clinical leadership, systems & incentives • Brief interventions • Behaviour change skills • Knowledge of quit smoking services & referral • Prescribing knowledge & medications available • Measure outcomes and provide feedback • Acute Trust and Mental Health Trust CQINs 8
• 9.
  9
• 10.
  Are your hospitalstaff able, & confident to, prescribe Quit Smoking medication? Does your hospital provide nicotine replacement therapy routinely on admission for smokers? How do we make this happen? 10
• 11.
  What did wedo? More about LRT and Right Care @ www.londonrespiratoryteamconference.com 11
• 12.
  12