COPD Health Forecasting Service Cwm Taf Local Health Board

1. 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.

4. Excess Winter Mortality

5. 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.

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

13. What we found in the Pilot • Patient feedback overwhelmingly positive • Practice enthusiasm • Recognition of increased awareness of the impact on patients

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.

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

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. 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. Thank you Michelle Lloyd Cwm Taf Health BoardMichelle.Lloyd3@wales.nhs.uk 01443 744842