Could an intervention to improve self-management of Chronic Obstructive Pulmonary Disease (COPD) in primary care be delivered through Shared Medical Appointments (SMA)? A feasibility study.

Problem

COPD, characterised by persistent respiratory symptoms that includes breathlessness, cough and/or sputum production due to airflow limitation, is a significant burden for primary care practitioners to manage. Self-management is recognised as a critical component in the care of COPD and evidence has demonstrated that self-management interventions (SMIs) are effective in improving health-related quality of life and reducing healthcare costs related to frequent acute exacerbation and unnecessary hospital admissions.Shared Medical Appointments (SMAs), where small groups of patients meeting with clinicians for comprehensive care, are emerging as an approach that can address many of the issues that affects self-management of chronic conditions. SMAs, are currently being trialled as a new form of providing annual reviews for COPD and other conditions in some primary care practices in England. While most SMA studies have focussed on diabetes, heart diseases, asthma and hypertension, there is no evidence regarding the acceptability and feasibility the use of SMAs for COPD consultations in primary care.

Approach

Findings from our larger programme of work (systematic reviews, qualitative interviews and participatory workshops) were used to develop and guide the content and structure of a SMA model to deliver a COPD SMI in a GP practice. Our SMA model consists of two components; 1) a group session that comprises of individual patient assessments, medication support, and a clinical consultation session with the GP, facilitated by a practice nurse; 2) a one-on-one follow up session held with a practice nurse or healthcare assistant within 2 – 4 weeks after the group session with a focus on social prescribing. COPD patients are invited by the GP practices following the usual procedure to attend their annual medical reviews. The SMAs are run by the usual clinical team at the GP practice; the GP, practice nurse, pharmacist and/or a healthcare assistant.

Findings

This SMA model is currently being evaluated to examine its feasibility and acceptability. The ongoing qualitative evaluation with patients and healthcare practitioners is focused on issues regarding patient recruitment, attendance, engagement, and satisfaction with the intervention. Early findings from both patients and practitioners perspectives indicate that the SMAs has significant promise in improving COPD self-management. It has however experienced implementation difficulties such as practitioner training and confidence in delivering a group appointment and the additional administration and organisational burden for practice staff. It is also recognised that this intervention cannot reach all patients (e.g. the housebound) and the group setting may not be suitable for some patients.

Consequences

While it is recognised that there cannot be a ‘one-size-fits-all” intervention, the SMAs presents an opportunity to explore a novel approach to deliver a COPD SMI that simultaneously addresses many of the key issues affecting self-management of COPD that are important to both patients and primary care practitioners.