Breakout 4.2 Optimise not maximise for better value COPD and asthma care - Noel Baxter Co-lead NHS London Respiratory Team Part of a set of presentations from NHS Improvement event: Better value, better outcomes held on Thursday 21 February 2013, Guoman Tower Hotel, London How to deliver quality and value in chronic care:sharing the learning from the respiratory programme

1. Optimise not maximise for
better value COPD & asthma
care
Noel Baxter GP
Co-lead NHS London Respiratory Team
The VALUE equation
Health
Outcomes Value Cost
=
Patient defined
Health Outcomes
bundle of care
Cost of delivering
Outcomes
Porter ME; Lee TH NEJM 2010;363:2477-2481; 2481-2483
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2. We know what interventions are good value –
when they are done in the right way
Triple Therapy
£35,000-
£187,000/QALY
LABA
£8,000/QALY
Tiotropium
£7,000/QALY
Pulmonary Rehabilitation
£2,000-8,000/QALY
Stop Smoking Support with
pharmacotherapy £2,000/QALY
Flu vaccination £1,000/QALY in “at risk” population
What works long term and is cost effective?
A cost effective intervention in COPD - Stopping Smoking
1 year abstinence QALY
% £
Usual care 1.4
Minimal counselling 2.6 14,735
Intensive counselling 6 7,149
Intensive counselling + 12.3 2,092
pharmacotherapy
Systematic Review of 9 studies Hoogendoorn M, Feenstra TL, Hoogenveen RT, Rutten-van Mo¨lken MPMH.
Thorax 2010: 65:711-718
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3. The low value pyramid
We know how to allocate resource at
population level
http://www.impressresp.com/index.php?option=c
om_content&view=article&id=167:impressions-28-
relative-value-of-copd-
interventions&catid=11:impressions&Itemid=3
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4. COPD in London: What do we know?
Londoners dying from smoking
‘1 in 5 deaths due to
smoking’
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5. Stop smoking support: Step 1 treatment for
people with asthma who smoke and for
households of children with asthma that
smoke
“ 32.5% of patients admitted to hospital were current smokers …a further
18.8% were ex‐smokers …a significantly greater number of asthmatics reported
themselves to be smokers over the general population …
… smoking causes steroid resistance in asthma and is associated with other
‘risk’ behaviours, which may make this group more likely to be admitted to
hospital
Optimal healthcare for up to 1:4 people with a
long term condition is stop smoking support as
treatment
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6. Admissions ( asthma and COPD) : What factors
can we influence as health professionals ?
• Bed capacity
• Distance to hospital
• Deprivation of population
• Socioeconomic status
• Prevalence of COPD
• Prevalence of smoking in our practices
Where can we make an impact for people
with COPD and asthma ?
• For every 1% increase in prevalence of
smoking in your COPD population there is a
1% increase in COPD admission rates.
• For every 1% increase in prevalence of
smoking in your asthma population there is a
1% increase in asthma admission rates.
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8. PCT monthly COPD dashboard 2013
Prevalence of current
smoking where status 1550/3335 = 46.5%
recorded in last 15 months
COPD smokers in last year receiving evidence based stop smoking
support – 17.5%
Quit smoking as treatment
Sharing Whittington learning
Health professionals esp doctors need to believe quit smoking
interventions are part of their role & responsibility
Behaviour change: importance, confidence
Make it easy to do
clinical leadership, systems & incentives
• Brief interventions
• Behaviour change skills
• Knowledge of quit smoking services & referral
• Prescribing knowledge & medications available
• Measure outcomes and provide feedback
• Acute Trust and Mental Health Trust CQINs
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10. Are your hospital staff able, & confident
to, prescribe Quit Smoking medication?
Does your hospital provide nicotine
replacement therapy routinely on
admission for smokers?
How do we make this happen?
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11. What did we do?
More about LRT and Right Care @
www.londonrespiratoryteamconference.com
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