Southwark Clinical Commissioning Group Lambeth Clinical Commissioning Group

Detecting breathlessness and structured assessment in primary care

Dr Noel Baxter, GP & Clinical lead

NHS Southwark CCG

What works for repeated locally

703,845 population

COPD – 7773Asthma – 31,005HF – 3,016LTC & Smoker – 21,077

The breathlessness working group

Expertise Experts

Palliative care & breathlessness support Irene Higginson, Charles Reilly

Respiratory Physiotherapy Leyla Osman, Kevin Taylor, Lynn McDonnell

Clinical Psychology Janet Wingrove

Patients and Carers Breathe Easy Southwark

Commissioning Leah Herridge, Ali Young , Alicia Reeves

GPs Eric Cajeat, Jonty Heaversedge, Azhar Saleem, Noel Baxter

Cardiologist Gerry Carr-White, Jonathan Byrne

Respiratory physician Nicholas Hart, Irem Patel

Exercise on prescription service Rosie Dalton-Lucas, Agata Roszczynska

Diabetes, Metabolic Medicine, Obesity

Cardiovascular pharmacist Helen Williams

Acute trust service manager Donna Grier

How do people with breathlessness present?Daily disabling breathlessness

10% of adults suffer long-term breathlessness. Do they recognise and tell and do we notice and systematically take action?

What could it be?

Estimating prevalence through coding behaviour

All patients ever registered

Patients aged over 40

Coded as breathless

sex

BMI

smoking history

associated diagnosis diagnosed

with COPD

diagnosed with heart failure

diagnosed with COPD and

heart failure

Coding for breathlessness

SOB: Problem

SOB: Measure or finding

Southwark – What is the prevalence ?

Adult population : 410,868 patients over the age of 40 with an electronic record at one of 40 GP surgeries

Characterising the breathless population

Current Smoker COPD Never smoked & BMI <28

BMI>35 Heart Failure COPD & Heart failure 0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

44%

35%

28%

20%

9%

4%

COPD Register 2013 – Did we exclude other causes in these patients?

Breathlessness activity in 2012 ?

Patients continuously registered between

1.1.12-31.12.12Over 40

Coded as breathless

sex

age

BMI

smoking history

associated diagnosis

COPD

asthma

asthma and obesity

asthma and copd

copd and heart failure

heart failure

none of aboveBreathlessness

coded as problem header

sex

age

BMI

Smoking history

associated diagnosis

asthma

COPD

Not asthma, COPD, heart

failure,

Prevalence of breathlessness activity (coding) as a proportion of the over 40s per practice

10x variation

Prevalence of breathlessness activity (coding) as a proportion of the over 40s per practice

Smoking highly prevalent in people coded as breathless

Where breathlessness is recorded as a problem current smoking is less prevalent than population rate

Localised breathlessness assessment process

Signposting to services already commissioned

Prioritising psychological/dietary/activity interventions

Implementing primary care improvement with peer review and support

ABCs for breathless people

EQUIP = Effecting Quality in Practice