Integration of Respiratory Services

Introduction: Key drivers for change: Management of respiratory conditions has historically been by secondary care in response to acute presentations. Chronic Obstructive Pulmonary Disease (COPD) is the 4th cause of death in New Zealand. New Zealand has the 2nd highest prevalence of asthma; high death rates due to this disease; 6 times higher for Pacific, 5 times higher for Maori, and respiratory conditions are responsible for 20% of acute presentations to ED.Short description of practice change implemented: The Respiratory Project aimed to form an evidence based pathway of integrated care for patients diagnosed or suspected with respiratory disease, encompassing accurate diagnosis, dedicated protected time for patient education enabling self-management and improved quality of life.Aim and theory of change: A shared passion has driven implementing early intervention lead by primary care, developing a competent workforce and removal of sector boundaries which enable primary care to be clinically responsive.A Nurse Led service was developed in primary care to support delivery of spirometry across 18 practices. The Respiratory Clinical Nurse Specialist and Breathe Hawke’s Bay Educators became mentors for practice nurses, the Respiratory Scientist (secondary) facilitated the upskilling of Practice Nurse Champions, endorsing accreditation of the quality spirometry services and investigation.The development of an advanced form included a diagnostic support and a care planning tool which is task managed. Nurses and patients facilitated joint care planning. Priority has been given to education of patients enabling good understand of their condition, empowerment to be active partners in their own health and well-being and improving their health literacy.Targeted population and stakeholders: Risk stratification of practice populations provided an assurance of reaching the most vulnerable.Patients, Practice Nurse Champions, Specialist CNS, Breathe Nurse Educators, Respiratory Scientist, Health Intelligence Team, all key stakeholders in the success of this programme.Timeline: Twenty-month pilot, now ‘business as usual’.Highlights: (innovation, impact, outcomes) An obvious growth in patient knowledge and quality of lifeImproved quality of services in primary care leading to greater equity of careIncrease in spirometry services of 225%Decrease in secondary service referrals from 658(2012) to 28(2015)Decrease in bed days by 740 daysDecrease in LOS, decrease in ED present