Knowsley Council’s substance misuse service has teamed up with the Liverpool Chest and Heart Hospital to offer testing and treatment for respiratory problems.
The clinics – run at two of the substance misuse service’s centres – are helping to identify previously undiagnosed cases of respiratory problems.
The challenge
Chronic obstructive pulmonary disease (COPD) is an umbrella term used to describe progressive lung diseases including emphysema and chronic bronchitis.
These diseases are characterised by increasing breathlessness, a cough and wheeze. COPD cannot be cured, but can be effectively treated. Treatment can only be provided following an accurate diagnosis and improves health-related quality of life along with reducing the risk of flare-ups in the disease.
Heroin and crack smoking is association with early on-set of severe COPD, but drug users tend not to engage with non-emergency medical services, such as respiratory clinics.
The solution
For the last seven years Liverpool Heart and Chest Hospital has been providing community COPD services across the Merseyside area.
This includes everything from diagnostic testing through to rehabilitation and crisis response teams to prevent emergency admission.
To help engage people using substances in Knowsley, the council’s drug and alcohol and treatment service – run by Change Grow Live – and the hospital’s community team started working in partnership at the start of 2018.
The project involves community diagnostic staff providing spirometry tests in conjunction with routine key worker appointments at of two of the substance misuse service’s centres. A spirometry is a simple test that gets an individual to breathe into a mouthpiece and measures how much they can breathe out.
If an abnormal result is registered or they have lots of symptoms of respiratory disease the individual is then booked in to see a consultant to make a formal diagnosis.
Both the diagnostic clinics and consultant clinics take part weekly split between the two centres. Once a diagnosis is confirmed the patients are given access to the other services and offered support in the community.
Knowsley’s Integrated Recovery Service Manager Zac McMaster said: “We had been looking to do this for some time. We have more regular contact with anyone facing difficulties with substances than the hospital or primary care do so it makes sense to offer them health testing while they are with us.”
The impact
The project has had an immediate impact. During the first three months, more than 60 patients attended spirometry. Of those, 45 per cent had abnormal results consistent with a diagnosis of COPD.
So far just over three-quarters of those with abnormal results have had that diagnosis confirmed. The overwhelming majority had no idea they had COPD - and of those who had had a previous diagnosis, half were not taking treatment to manage their condition or were not taking treatment properly.
“You can see it is working really well,” said Mr McMaster. “The majority of people who have been diagnosed would be walking round unaware that they had a respiratory problem, not getting treated and ending up with their health getting worse.”
Respiratory disease consultant Sarah Sibley agrees. She said working with the substance misuse service was a “fantastic opportunity” to reach a group of people at high risk who don’t engage with traditional healthcare services.
“This joint venture is allowing us to help find ‘the missing millions’ of people who have COPD but are undiagnosed. Only by the early and accurate diagnosis of COPD can we help to improve health outcomes. It’s early days, but we are already seeing great benefits from our joint working and look forward to seeing the full impact.”
Lessons learned
When the project started the spirometry tests worked entirely through a booking procedure with the key worker using an online system to book their clients an appointment in the forthcoming weeks. The team soon found clients were not always turning up or arrived at the wrong times.
So, as the scheme has progressed, the approach has been changed.
Only about half the appointments are booked in advance now, leaving the rest available for opportunistic testing. When people are waiting for their key worker appointment, the spirometry team will go into the waiting room to offer testing or if people come in asking for a test there will normally be availability.
How the approach is being sustained
The success of the programme has convinced the partners to keep offering the testing.
In fact, they are in the process of recruiting a new member of staff. A healthcare assistant is being appointment to work with the drug and alcohol key workers and hospital staff to chase up patients to attend appointment and help get people in for the opportunistic testing. “We think it will make it more efficient and ensure we are able to get as many people as possible tested,” said Mr McMaster.
Contact details
Zac McMaster
Knowsley’s Integrated Recovery Service Manager Change Grow [email protected]