COPD Self Management Mike Scott. GP Newburn Surgery
A YEAR IN THE LIFE I have to deal with my illness all the time, that’s about half a million minutes a year. I see my doctor about it for about forty of them
CARE PLANNING (IMPROVING THE LIFE OF PATIENTS WITH LTC) Good evidence that our care of people with LTCs can be improved. Patients tell us they want us to do more to support their own self-care. This is not happening. 95% of diabetics, are seen annually, 50% discuss a management plan, less than 50% discuss their goals for self management. Reluctance of clinical staff to provide active support for patient engagement. Shared decision making is less common in the UK than elsewhere Lack of engagement by patients, which include a failure to attend follow-up appointments. Uptake of patient education, when offered is poor 50% of the medication prescribed for LTCs is not taken, or as prescribed RCGP 2011
ISSUE OF SELF MANAGEMENT PLANS
PATIENTS WITH SUPPORTED SELF CARE experience better health and well-being reduce the perceived severity of their symptoms, including pain improve medicines compliance prevent the need for emergency health and social services prevent unnecessary hospital admissions have better planned and co-ordinated care remain in their own home have greater confidence and a sense of control have better mental health and less depression Care Planning, improving the life of patients with long term conditions
OTHER REPORTED SELF CARE BENEFITS Less duplication of effort Improved patient satisfaction Reduced visits to GPs Reduced hospital admissions Decreased number of days in hospital Reduced outpatient visits Reduced A&E visits Reduced medication expenditure Improved medicine utilisation We all think we do this
THEY DON’T MEAN ME? You never see the same doctor twice I have managed my condition for years They don’t listen I know my body better than anyone else There is never enough time I forget what's been said They just want to prescribe If I don’t know what the drug is for I don’t take it Managing my condition myself gives me more control Its hard to know what all the numbers mean A lack of respect on both sides? programmes/long-term-conditions-and- integrated-care/navigating-health-and- care.aspx
A THERAPEUTIC RELATIONSHIP A named contact Listen, to understand the patients perspective Explain clearly the clinicians perspective Understanding shared data Agree a plan What is this for? How do I use it? When do I use it? What are my responsibilities? Written goals and explanation (BLF) Clear data available Measure progress at next visit (continuing care)
EXACERBATION FREQUENCY RECORDING
PATIENT V CLINICIAN Do I really need all this stuff? Do they realise how tired I am? I think the Amoxycillin makes me cough Is the ankle swelling important? Is vaping OK? How much wine can I have with this? Why have I not improved? Would oxygen help? My sister has a different inhaler Am I going to suffocate? Inhalers ? The right ones properly used (check technique and the number of prescriptions collected) Smoking Vaccinations Co mobidities? Recue pack? Mood? Osteoporosis risk? Smoking? QOF?
PATIENT AND CLINICIAN Can leave with concerns addressed and a plan to deal with the challenges they face. A plan with clear guidance of how to maintain best health and how to meet problems including information on who to contact Enough time, privacy, equipment and information A Template which collects all the information together and acts as a series of prompts.
RESCUE PACKS Patient gets a course of steroid and antibiotic with written information When to start The need to complete How to recognise if it is effective What action to take if it is not (CHEST?) Instructions to inform practice when it has been used The Practice must monitor their use Are the criteria for its use correct? Does this effect the preventative regime? Do we continue? Do we now need bone protection? Rescue Packs are not synonymous with self care plans
“HOUSE OF CARE’ PRACTICE The evidence is that it pays dividends, including clinician satisfaction. Thanks!