|Title:||Utilization of Specialist Palliative Care (SPC) in the management of advanced Chronic Obstructive Pulmonary Disease (COPD) in St John’s Hospital|
|Author(s):||C Farrell, A Scott|
|Institution:||St John's Hospital Limerick|
|Poster:||Click to view poster|
|Category:||Asthma and COPD|
Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death worldwide accounting for almost twice that of lung cancer. After first hospitalisation for an AECOPD 50% die within 3.6 years. Patients with COPD have a high symptom burden with breathlessness, fatigue, cough and anxiety. Guidelines recommend that patients with advanced disease should receive early access to Specialist Palliative Care (SPC). In the UK, 16.7 – 17.9% of patients with COPD accessed SPC in their last year of life.
This is a retrospective review of COPD patients selected from the pulmonary rehabilitation database in St John’s Hospital of Limerick. Total number of patients referred for pulmonary rehab over the last two years are recorded. Using the combined COPD assessment, the disease severity is recorded. A review of charts and Inpatient Management System (IPMS) was used to record data and determine if SPC reviewed and are linked in. A chart review was performed to determine if treatment included opioids or benzodiazepams, long term oxygen therapy (LTOT) or non-invasive ventilation (NIV). Hospital admissions and 90-day re-admission rate are recorded.
47 patients in total referred for pulmonary rehabilitation in the last 2 years in St Johns with 33 completing it.
Certain barriers may account for low uptake in Specialist Palliative Care services including 1.) Access and availability to SPC services 2.) Difficulty prognosticating due to variable disease trajectory 3.) Clinicians lacking time to discuss palliative care 4.) Clinicians fearful of what palliative care entails. An integrated approach is important with SPC involvement in end stage pulmonary disease. How can we improve appropriate referral numbers to SPC? A simple questionnaire for patients with advanced disease on participation in pulmonary rehabilitation or review in clinic could be considered.