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COPD Health Forecasting
Service Cwm Taf Local
Health BoardMichelle Lloyd
Service Development Manager
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.
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.
Excess Winter Mortality
© Crown copyright Met Office
The UK is high up the European league for additional winter mortality
27 00016%Italy
5 70018%Greece
37 00018%UK in total
3 10016%Scotland
80017%Northern Ireland
1 80017%Wales
31 00019%England
19 00021%Spain
2 00021%Ireland
8 80028%Portugal
Number of premature winter deaths
Approx. % increase in premature deaths
Country
Excess winter mortality
A forecast model has been developed by the MET Office to predict the risk of COPD exacerbations
The main triggers are:-Cold temperaturesVirus levelsHumidityBoundary layerSeasonal variation
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.
Health forecasting is about moving from…
to
This is the weather
This is the impact on health
Reaction to impact
This is the relationship between
weather & health
This is the forecast of weather and risk
to health
Prevention of impact
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
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.
Clinically valid interventions
Healthy Outlook™ System
NHS Network
Medixine softwareon NHS Server
Medixineinteractive voiceresponse system
Medixineadministrator
Monitoring
HealthForecasts
Automatedtelephone call
Patientresponses
Telephonenumbers
Patient name andtel no, changes to
patient status
Call logs
Met Office Forecaster
Person withCOPD
GP practice Patientresponses
HOW IT WORKS
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
What we found……..
Total Admissions for Particpating Practices
-10
-5
0
5
10
15
20
Apr-0
5
Jun-
05
Aug-
05
Oct-0
5
Dec-
05
Feb-
06
Apr-0
6
Jun-
06
Aug-
06
Oct-0
6
Dec-
06
Feb-
07
Apr-0
7
Jun-
07
Aug-
07
Oct-0
7
Dec-
07
Feb-
08
Period
Indi
vidu
al V
alue
Special Cause Flag
What we found in the Pilot
• Patient feedback overwhelmingly positive• Practice enthusiasm• Recognition of increased awareness of the
impact on patients
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
“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.”
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.
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
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
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.
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.
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
