1. Service Development Manager
COPD Health Forecasting Service Cwm Taf Local Health Board
Michelle Lloyd
Service Development Manager

2. Background
“Healthy Outlook” is an innovative Met Office service that uses specific weather conditions to predict periods of high risk for people with Chronic Obstructive Pulmonary Disease (COPD). This service helps keep people with COPD well and out of hospital during the winter.

3. The service is based on the following:-
There is a strong correlation between the weather in winter and the
health of people with COPD.
A peak in COPD hospital admissions typically occurs 10 – 12 days after
a cold weather event.
This peak in admissions can be amplified by high levels of respiratory
infections.
Accurate COPD health risk forecasts are possible by combining the
weather with factors such as respiratory viruses and seasonal patterns.
These forecasts are used to trigger an automated call to alert COPD
patients to the upcoming high-risk period.
These calls prompt patients to adopt a set of simple anticipatory
measures to help keep themselves well during the winter.
Calculated from total emergency medical admissions

4. Excess Winter Mortality
Bill Keatinge work
This country shivers more and is the most inactive at 7 C than any other country in Europe.
Hats anoraks and tousers along with warm indoors prevent this extra death rate.
Russia has no EWM despite temps down to –40.

5. The main triggers are:- Cold temperatures Virus levels Humidity
A forecast model has been developed by the MET Office to predict the risk of COPD exacerbations
The main triggers are:-
Cold temperatures
Virus levels
Humidity
Boundary layer
Seasonal variation

6. Aims of the Service
To Provide COPD patients with information on how to proactively manage their condition and identify individuals most at risk of becoming ill or of their condition deteriorating due to changes in the environment.
Reaching these patients early can help to prevent their symptoms deteriorating and reduce the need for hospital admission.
Winter peaks

7. Health forecasting is about moving from…
This is the relationship between weather & health
This is the forecast of weather and risk to health
Prevention of impact
This is the weather
This is the impact on health
Reaction to impact to

8. Clinically valid interventions
Clinically valid interventions for patient and healthcare professionals developed and endorsed by the MET Office’s COPD Clinical Advisory Group, chaired by Dr David Halpin.
The interventions are:
Early reporting of symptoms
Available medication
Keeping the house warm
Appropriate outdoor clothing
Increasing Physical activity
Management of Anxiety and depression
Treatment based on NICE Guidelines

9. Healthy Outlook™ System
HOW IT WORKS

11. Implementing the service in Cwm Taf
Piloted Winter 2007/08
7 GP Practices
226 patients participated
Patient Education Pack
Anticipatory Care Advice
Signposting to Services
Access to Practice when required

12. What we found……..
The pilot in our area was very successful. One of the factors we used to evaluate the impact of the scheme was hospital admissions.
This slide demonstrates that in those Practices involved in the pilot their admission rate fell during the course of the pilot.
Reduction in admissions is very important:
Average length of stay 7.1 days
Disruption for the patient
Impact on patients function and general well-being
Average cost of an admission to hospital for COPD is £1,600

13. What we found in the Pilot
Period December - March
Participating Practices
Non-Participating Practices
2007/08 compared to 2006/07
70% decrease in admissions
28% decrease in admissions
2007/08 compared to 2005/06
63% decrease in admissions
18% decrease in admissions
Patient feedback overwhelmingly positive
Practice enthusiasm
Recognition of increased awareness of the impact on patients
We also compared the 7 Practices to all other Practices across Rhondda Cynon Taff.
This is more significant as we can see that whilst all Practices witnessed a reduction in admissions for COPD compared to the previous 2 winters, the reduction for participating practices was notably more significant.
We also collected patient and Practice staff feedback as part of our evaluation. Patients were extremely positive about the service and comments included feelings of reassurance and added confidence knowing that they were being included in this scheme.
Practices also felt that it was not only the patients who were more aware of their condition during this time and felt that they were more focussed and aware of this group of patients as a result of the service.

14. Patient Feedback
“It makes sure I have my medication at the appropriate time as before I had difficulty obtaining it from the surgery when I most needed it. It also gives me the assurance of knowing I always have my course of medication ready in case of an attack especially during holiday periods when the doctors are closed.”
“I found the service very reassuring gave me peace of mind as my doctors surgery would phone me, when and if answered no to the automated Q to know that I would be contacted by my surgery was a bonus, thank you.”
“I find them very helpful, it as made me look after myself more over the winter months, I have not been without my medication this winter because of these calls, thank you.”

15. Mainstreaming the Service
Roll-out of service across Rhondda Cynon Taff and Merthyr Tydfil
30 Practices
934 patients registered
Number of alerts varies each winter (4/5)
Those practices involved in the pilot in 07/08 saw a further 19.3% reduction in admissions in 08/09.
Practices who signed up for the service in the winter of 08/09 saw their admissions reduce by 3%.
Across Rhondda Cynon Taff and Merthyr Tydfil, those practices not involved in the scheme remained at 07/08 levels in terms of admissions for COPD.
Within Rhondda Cynon Taff we very enthusiastic about the service.
The results we saw in our pilot highlighted the potential impact of the service in terms of admissions to hospital however the increased recognition amongst patients as to how they can take some simple steps during the winter to stay well and the feedback they have provided demonstrates to us why we should continue this.
We are keen to see the impact of the scheme this year given the very cold weather we’ve experienced as well as high levels of cold and flu viruses.

16. Benefits Cost benefit analysis favourable Reduction in admissions
Positive for patient and health service
By assumption patients had less exacerbations
Anecdotal feedback
Improved knowledge and awareness
Confidence
In summary we feel there are a number of benefits associated with implementing this service in our locality.
The cost of implementing the service is minimal compared to the cost of multiple admissions to hospital.
Patients had less or milder exacerbations as their symptoms were recognised earlier.
As I said earlier the feedback from patients has been extremely positive and those involved in the pilot were keen to see it continue.
Our evaluation of this winter will be extremely interesting as we have a larger sample of patients but also have experienced a very different winter to last year in comparison to temperature and large numbers of viruses.
Thank you for your time.

17. Challenges / Lessons Learnt
Practice Sign Up
Time constraints in visiting practices in order to roll out the service
Perception of which patients can benefit the most – not always the case
I.T. skills within Practices
Project management support required
Issues in relation to fuel poverty / home environment
Need to remind some practices to continue recruiting and offering the service to COPD patients
Turnover of staff in some practices have meant retraining

18. Prevention: Reducing the Risks
Where this fits into the Service Development and Commissioning Directive : Chronic Respiratory Conditions
Prevention: Reducing the Risks
By Sept 2008 appropriate and evidence based primary and secondary prevention measures for chronic respiratory conditions will be established as part of mainstream service provision
By Dec 2008 appropriate health promotion information and advice on respiratory health will be made easily available to the general public and specifically targeted at people with chronic respiratory conditions and those in other high risk categories.
Diagnosis, Treatment & Management
NHS Commissioners will ensure that new and emerging technologies are utilised to facilitate early assessment and diagnosis of chronic respiratory conditions in primary, secondary and tertiary care.
By September 2008 rehabilitation programmes, including pulmonary rehabilitation, will be available to support people with chronic respiratory conditions in the community in line with National and Professional guidance.

19. Contd.. Facilitating and Managing Independence
By July 2008 individual care plans will include a category for self management ensuring access to the Expert Patients Programme courses for people with chronic conditions. COPD Health Forecasting can be included in Individual care plans.

20. Next Steps for Cwm Taf
To continue to raise awareness of COPD Health Forecasting and to roll out to additional practices in RCT
To continue to encourage practices to raise awareness of the service and to recruit additional COPD patients
To undertake an evaluation of last Winter

21. Cwm Taf Health Board Michelle.Lloyd3@wales.nhs.uk
Thank you
Michelle Lloyd
Cwm Taf Health Board