Background COPD kills 25 000 people per year in England and Wales. NICE guidelines suggest patients with end-stage COPD should have access to palliative services. GSF prognostic indicators assist clinicians to identify patients who are approaching end of life at an earlier stage enabling appropriate interventions to take place. These patients are more likely to receive well-coordinated and high-quality care. The aim of our study was to map the number of QoF registered COPD patients in Wolverhampton, the frequency of COPD specific GSF indicators, the number included on primary palliative care registers (‰¥2 GSF prognostic indicators) and the number reviewed by palliative care.
Methods A multidisciplinary group with membership from CCG, acute trust, hospice and the community team oversaw the project. Data was collated from across all health care sites enabling us to confirm the number and type of GSF prognostic indicators for each patient and healthcare activity including palliative care reviews.
Results In March 2016 there were 4999 COPD patients; 52% were male with an average age of 69.2 years. 24.6% of the patients (n=1232) had ‰¥1 GSF prognostic indicator. The most common indicator was MRC dyspnoea score of 4/5 (58.4%), followed by body mass index <20 (22.9%). Of the 254 patients with ‰¥2 GSF prognostic indicators 15.4% were on the GP palliative care register. 20.1% of the 254 patients had been reviewed by the palliative care team.
Conclusion GSF prognostic indicators in COPD are prevalent with breathlessness being the most common. Only a small proportion of appropriate patients were included on the palliative care register (15.4%) with more being seen by palliative care teams than on the registers. Further work is needed to ensure effective communication and education is provided across the whole health care system to identify patients earlier who are approaching end of life.
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