Authors (including presenting author) :
Wong SK(1), Man FY(1), Lai FS(1), Leung SH(1), Chen XR Catherine(1), Li YC(1), Ko SH(1)
Affiliation :
(1)Department of Family Medicine and Primary Healthcare, Kowloon Central Cluster
Introduction :
Asthma and chronic obstructive pulmonary disease (COPD) are common chronic respiratory conditions that challenge healthcare systems. The Nursing and Allied Health Clinic - Respiratory Disease (NAHC-RD) program in the Kowloon Central Cluster (KCC) has offered specialized care for COPD patients for over 10 years. In April 2023, the program expanded to include adult asthma patient, necessitating new strategies for effective management.
Objectives :
1. Provide multidisciplinary assessment and education for patients at high risk of developing COPD or asthma
2. Provide proper assessment, risk stratification, clinical management and rehabilitation for adults with COPD or asthma, enhancing self-empowerment
Methodology :
1. Service expansion: We have broadened our service to include spirometry and respiratory doctor sessions at three general out-patient clinics to provide convenient patient access. Patients are stratified based on assessment results, with early respiratory doctor appointments scheduled for those with suboptimal asthma and COPD control.
2. Comprehensive Assessment and Patient Education: Each doctor’s session includes a detailed assessment using Asthma Control Test (ACT) score and Peak Expiratory Flow Rate (PEFR) for asthma patients, and modified Medical Research Council (mMRC) and COPD Assessment Test (CAT) score for COPD patients. Inhaler techniques and compliance are checked, and patient education is provided.
3. Expanded Inhaler Choices: A wider selection of inhaler in line with the latest Asthma and COPD guidelines are provided, including long-acting beta-agonists (LABA), long-acting muscarinic antagonists (LAMA), and combination inhalers (LABA+ICS and LABA+LAMA) are offered.
4. Healthcare Professional Training: Staff promulgation and training sessions were conducted to introduce the updated service and enhance professional skills.
5. Multidisciplinary Collaboration: Nurses, physiotherapists, and occupational therapists worked together to provide comprehensive patient education and chronic disease self-management.
Result & Outcome :
After one year of program’s expansion, by April 2024, 311 patients were enrolled in the doctor’s session for asthma or COPD management. Among them, 162 had COPD, 127 had asthma and 16 had asthma-COPD overlap.
For COPD cases, 32 patients were initially classified in GOLD group A, 92 in group B and 31 in group E. After one year, those numbers changed to 54, 50 and 27 respectively. The mean CAT score improved from 8.67 to 6.94 and the mean mMRC score decreased from 1.86 to 1.50. Lung function showed improvement also, with FEV1/FVC increasing from 39.54% to 54.95%.
In asthma cases, initial data showed 31 patients with good control, 55 with partial control and 35 with uncontrolled asthma. After one year, these figures changed to 73, 16 and 7 respectively. The mean ACT score improved from 17.30 to 21.21 after 1 year.
In conclusion, the expansion of services and the adoption of various strategies within the NAHC-RD program have significantly improved the patient management of asthma and COPD in the primary care setting. The availability of spirometry services, expanded inhaler choices, comprehensive assessments, patient education, healthcare professional training, and multidisciplinary collaboration have collectively contributed to enhanced care delivery and improved patient outcomes.
