Authors (including presenting author) :
Wong SK (1), Man FY (1), Lai FS (1), Leung SH (1), Ko SH (1), Chen XR Catherine (1), Li YC (1)
Affiliation :
(1) Department of Family Medicine and General Outpatient Clinic, Kowloon Central Cluster
Introduction :
Asthma and chronic obstructive pulmonary disease (COPD) are prevalent chronic respiratory conditions that pose challenges to healthcare systems. The Nursing and Allied Health Clinic - Respiratory Disease (NAHC-RD) program in the Kowloon Central Cluster (KCC) has been providing specialized care for COPD patients or those at risk of developing COPD for over 10 years. In April 2023, the program expanded its services to include adult asthma patients or patients suspected to have asthma. This service expansion necessitated the adoption of different improvement strategies to provide effective management for these conditions.
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 rehabilitative intervention for adult patients with COPD or asthma and to improve their self-empowerment
Methodology :
First, the NAHC-RD program in KCC has expanded its services to include spirometry services and respiratory doctor sessions at three general out-patient clinics located in Yau Tsim Mong, Kowloon City, and Wong Tai Sin districts, providing convenient access to patients in their respective areas. Patients are stratified based on assessment results, and early respiratory doctor appointments are arranged for timely intervention in cases of suboptimal asthma and COPD control. Second, comprehensive assessment and patient education are conducted for each patient during doctor's session, including evaluating disease control using measures such as 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 are provided. Third, a wider range of inhaler choices based on the latest Asthma and COPD guidelines are provided. In addition to SABA, SAMA and ICS puffs, long-acting beta-agonists (LABA), long-acting muscarinic antagonists (LAMA), and combination inhalers (LABA+ICS and LABA+LAMA) are now available, facilitating tailored treatment plans. Fourth, staff promulgation and nursing training were conducted to introduce the updated service and enhance the skills of healthcare professionals. Fifth, multidisciplinary collaboration including nurses, physiotherapists, and occupational therapists are emphasized to provide comprehensive patient education and chronic disease self-management. Brief pulmonary rehabilitation programs are offered to COPD patients with functional impairment.
Result & Outcome :
Following the program expansion, 131 COPD and asthma patients were enrolled in the respiratory doctor's sessions. Of the enrolled patients, 94 were male, 37 were female, and the mean age was 69.2 years. Regarding the COPD cases, 16 patients were classified under Global Initiative for Chronic Obstructive Lung Disease (GOLD) group A, 44 under GOLD group B and 15 under GOLD group E. As for the asthma cases, the average ACT score at the first visit was 17.2 out of 25. Notably, 23 patients achieved stability and were discharged to general outpatient clinics, while 11 patients required referral to specialist outpatient clinics. Three patients experienced exacerbations and sought treatment at the emergency department. In conclusion, the service expansion and the adoption of various strategies within the NAHC-RD program have significantly improved the 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.
