Community clinics help diagnose patients sooner and prevent hospital admissions

A handheld device is helping to screen and diagnose people with chronic lung conditions much sooner in the community.

GP practices across Swansea Bay have been given screening devices which help detect chronic obstructive pulmonary disease (COPD) and asthma.

If a GP suspects a patient may have a lung condition, they will be asked to complete a spirometry test – a lung function test that measures the amount and speed of air a person can breathe out in a single forced breath.

Pictured: Dr Kannan Muthuvairavan and respiratory specialist nurse Rebecca Bevan.

Those who receive a reading that identifies a form of obstruction in the lungs are then referred to a spirometry clinic based at either Estuary Group Practice in Gowerton or Dyfed Road Health Centre in Neath.

The spirometry clinics, which are held on weekends, are helping patients to be seen and diagnosed sooner while also bringing their care closer to home.

It has even gained national attention after being shortlisted in the Clinical Improvement – Public Health and Prevention category at the General Practice Awards, held in London in December.

Dr Kannan Muthuvairavan is the health board’s primary care lead for respiratory diseases and a GP at Estuary Group Practice.

He said: “The spirometry clinic builds on a previously successful community model, where just over a quarter of patients referred to it were diagnosed with COPD.

“This time, we have been able to create an additional clinic in Neath, to make it more convenient for patients.

“Previously, the GPs would refer any patient they thought needed to be screened for COPD to the spirometry clinic where we would screen them.

“We saw around 1,900 patients yet we identified 541 new patients with COPD.

“This time, we have introduced the screening device called COPD 6 to all participating GP practices, so they can screen their patients themselves to help them to decide if a referral to one of our clinics is necessary.”

During the first six months of the clinics being reintroduced, around 310 patients were referred.

200 of them had been screened with the device at their GP practice before being referred to the clinic and 70 per cent were confirmed to have COPD.

The remaining 110 patients were referred from non-participating practices so had not been screened first, and of those 30 per cent had COPD.

During the screening, patients are asked to blow into the COPD 6 device as hard and fast as they can. If there is an obstruction in the lungs as they blow out, it is likely to be caused by asthma or COPD.

November is COPD Awareness Month, dedicated to raising awareness of this chronic respiratory condition.

Chronic obstructive pulmonary disease is the collective name for a group of lung conditions that cause breathing difficulties.

During this month, we'll be highlighting the services, self-management guidance and support available to people living with COPD.

“Using the screening device first means that patients won’t be unnecessarily referred to the clinics to be tested further if it’s not needed,” Kannan added.

“The number of referrals we receive has come down because the device is helping to ensure the right patients are referred to the clinics.

“Once they have been referred to the spirometry clinic, they must blow into the device again so we can recheck their results.

“We then give them a Ventolin inhaler, which should help to open their airways, and ask them to wait 15 minutes before checking it again.

“If the result has improved and they are able to blow more air out than they did previously, we know it’s a reversible obstruction which is asthma.

“But if the condition didn’t improve, then it is irreversible which is COPD.”

The clinics have been helping to diagnose patients sooner, therefore reducing the risk of future hospital admissions had the condition gone undiagnosed.

There have also been large cost savings for the health board too.

Kannan said: “It is helping to reduce GP practice attendances, because undiagnosed patients are likely to attend their GP practice on average twice a year with flare-ups.

“Being able to diagnose patients much quicker will help reduce the risk of their condition worsening in the long run.

“Because we are diagnosing patients sooner, we are saving long-term costs by helping to prevent hospital admissions too.

“The COPD 6 is just a simple tool which costs us around £70 to £80 per device. But if a spirometry test is done in hospital it would cost around £200.”

The success of the clinics has even gained national attention after the health board presented a poster highlighting the project at the National Respiratory Leadership Forum recently held in London.

“AstraZeneca hosts the forum where leaders in COPD from almost every region attend,” Kannan added.

“They asked us to produce a poster about the spirometry clinics and it was accepted and we presented it at the event.

“It piqued a lot of interest and I have had people from across the UK contacting me to find out more about the device, how we have implemented it and if we can share information with them.”