Authors (including presenting author) :
Chen XR Catherine, Hui KW, Lai FC, Leung SH and Li YC
Introduction :
Chronic Obstructive Pulmonary Disease (COPD) is a common condition encountered in the primary care. Starting from 1 April, 2018, COPD audit has been conducted across all GOPCs of HA to review the performance of COPD management in the community so as to provide information for better strategic planning and for quality improvement on COPD care.
Methodology :
This is a clinic audit conducted at 13 primary care clinics of Kowloon Central Cluster of HA. All COPD patients who were aged 40 or above and have attended KCC GOPCs for regular FU were included. Evidence-based audit criteria and performance standards were established after thorough literature review. First-phase evaluation was performed in April, 2019 and deficiencies were identified. After 24 months of active intervention, second-phase evaluation was performed in April 2021. Chi squared test and student’s t test were used to compare the significance of relevant changes made between the two phases.
Result & Outcome :
Totally 2,358 COPD cases were identified in the first phase, among which 1886 (80%) had prescheduled appointments in GOPCs. Among the 658 smokers, only 332 (50.5%) had been referred to SCCS and 289 (43.9%) actually attended the SCCS. In addition, less than half of them received SIV (n= 991, 42%) and PCV (n=938, 39.8%) respectively. Furthermore, only 698 (29.6%) patients had spirometry done before and 423 cases (17.9%) had been admitted to hospital due to AECOPD. After identifying these deficiencies, a series of improvement strategies were carried out to fill in the service gaps. Dept. COPD audit working group was formed in April, 2018, with dept. subject officer assigned. COPD patient lists of each clinic were shared out to clinic IC and APN IC to follow. Staff education on how to manage COPD and prevent its acute exacerbation were promulgated to all front line staffs. All COPD cases without a regular FU apt had been phone contacted by clinic nurses to enquire about their disease control and arrange FU if needed. All COPD cases were advised to receive SIV or PCV during their routine FU and referred to Nursing and Allied Health Clinic (NAHC) for spirometry if not done. What’s more, COPD cases were grouped based on their clinical severity and different level of care was provided accordingly. With all these concerted effort, second phase data showed significance improvement almost in all criteria. Among the 1,687 COPD cases identified in the second phase, 1,470 (87.1%) had prescheduled appointments in GOPCs (P<0.00001). Almost half of them received SIV (n= 834, 49.4%) and PCV (n=1,050, 62.2%) respectively (both P<0.00001). Furthermore, a dramatic improvement has been seen in boosting up the spirometry performance rate (n= 1,252, 74.2%) and a significant reduction in AECOPD rate (n=99, 5.9%, P<0.00001). However, the SCCS referral rate and attendance rate among smokers were comparable between the two phases (both P>0.05).
Conclusion:
COPD management at primary care clinics of KCC have been tremendously improved during the past three years. Via a team approach with a streamlined governance and structure, regular staff promulgation and proactive staff engagement, significant improvement had been achieved in most of the audit criteria for COPD management, therefore reducing the burden to SOPD and hospital.
