title: Managing complex respiratory patients in the community: an evaluation of a pilot integrated respiratory care service.
abstract: BACKGROUND
  In the UK, there is significant variation in respiratory care and outcomes. An integrated approach to the management of high-risk respiratory patients, incorporating specialist and primary care teams' expertise, is the basis for new integrated respiratory services designed to reduce this variation; however, this model needs evaluating.
  
  
  METHODS
  To evaluate an integrated service managing high-risk respiratory patients, electronic searches for patients with asthma and chronic obstructive pulmonary disease at risk of poor outcomes were performed in two general practitioner (GP) practices in a local service-development initiative. Patients were reviewed at joint clinics by primary and secondary care professionals. GPs also nominated patients for inclusion. Reviews were delivered to best standards of care including assessments of diagnosis, control, spirometry, self-management, education, medication, inhaler technique and smoking cessation support. Follow-up of routine clinical data collected at 9-months postclinic were compared with seasonally matched 9-months prior to integrated review.
  
  
  RESULTS
  82 patients were identified, 55 attended. 13 (23.6%) had their primary diagnosis changed. In comparison with the seasonally adjusted baseline period, in the 9-month follow-up there was an increase in inhaled corticosteroid prescriptions of 23.3%, a reduction in short-acting β2-agonist prescription of 33.3%, a reduction in acute respiratory exacerbations of 67.6%, in unscheduled GP surgery visits of 53.3% and acute respiratory hospital admissions reduced from 3 to 0. Only 4 patients (7.3%) required referral to secondary care. Health economic evaluation showed respiratory-related costs per patient reduced by £231.86.
  
  
  CONCLUSIONS
  Patients with respiratory disease in this region at risk of suboptimal outcomes identified proactively and managed by an integrated team improved outcomes without the need for hospital referral.
authors.affiliation: National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Wessex, Respiratory Theme , Southampton , UK.
authors.forename: K
authors.initials: K
authors.lastname: Gillett
authors.affiliation: National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Wessex, Respiratory Theme , Southampton , UK.
authors.forename: K
authors.initials: K
authors.lastname: Lippiett
authors.affiliation: National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Wessex, Respiratory Theme , Southampton , UK.
authors.forename: C
authors.initials: C
authors.lastname: Astles
authors.affiliation: Wessex Academic Health Sciences Network (AHSN) , Portsmouth , UK.
authors.forename: J
authors.initials: J
authors.lastname: Longstaff
authors.affiliation: National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Wessex, Methodological Hub , Southampton , UK.
authors.forename: R
authors.initials: R
authors.lastname: Orlando
authors.affiliation: National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Wessex, Methodological Hub , Southampton , UK.
authors.forename: S X
authors.initials: SX
authors.lastname: Lin
authors.affiliation: West Hampshire Clinical Commissioning Group (CCG) , Eastleigh , UK.
authors.forename: A
authors.initials: A
authors.lastname: Powell
authors.affiliation: Wessex Academic Health Sciences Network (AHSN) , Portsmouth , UK.
authors.forename: C
authors.initials: C
authors.lastname: Roberts
authors.affiliation: Wessex Academic Health Sciences Network (AHSN) , Portsmouth , UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Chauhan
authors.affiliation: National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Wessex, Respiratory Theme, Southampton, UK; Department of Primary Care and Populations Sciences, University of Southampton, Southampton, UK.
authors.forename: M
authors.initials: M
authors.lastname: Thomas
authors.affiliation: National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Wessex, Respiratory Theme, Southampton, UK; Department of Clinical and Experimental Sciences, University of Southampton, Southampton, UK.
authors.forename: T M
authors.initials: TM
authors.lastname: Wilkinson
keywords: Asthma Guidelines; COPD Exacerbations; Health Economist