Background COPD kills almost 30 000 people per year in the UK (British Lung Foundation, 2016). NICE guidelines suggest patients with end-stage COPD should have access to palliative care services (NICE, 2010). Gold Standards Framework prognostic indicators assist clinicians to identify patients who are approaching end of life at an earlier stage enabling appropriate interventions to take place (2011). These patients are more likely to receive well-coordinated and high-quality care.
Aims The aim of our study was to map the number of QoF-registered COPD patients in our locality, 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 Clinical Commissioning Group, acute trust, hospice and 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 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 specialist palliative care teams than on the registers. Further work is needed to ensure effective communication and education is provided across the whole healthcare system to identify patients earlier who are approaching end of life.
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