Innovation Posters 814 – 819
814 A Review of the Use of Point-of-Care CRP Measurement to Aid the Management of Patients in General Practice
C-Reactive Protein (CRP) is an acute-phase protein that increases in concentration following inflammation, trauma, or infection. It is measured in primary and secondary care to detect pathology, and to aid treatment monitoring. Point-of-care testing is a form of investigation, performed with the patient present, to support clinical decision making. Antibiotic prescribing and the cost of unnecessary hospital admissions are both important topics in general practice, given the current financial strain on the NHS, and the antibiotic resistance crisis.
The purpose of this review was to assess point-of-care CRP testing in a primary care setting, and to analyse the impact on hospital admission and antibiotic prescribing. Furthermore, the financial implications were assessed. The review evaluated 139 patients who underwent point-of-care CRP testing in a 7 month period. Clinicians coded whether patients had been admitted or not, and similarly if antibiotics were prescribed or avoided, as a result of the CRP value.
Of the 139 patients, 25 avoided hospital admission, whilst 13 required admission. 101 patients avoided unnecessary antibiotic prescribing, with 18 requiring an antibiotic prescription. Point-of-care CRP testing appears to reduce hospital admissions and antibiotic prescribing in primary care. With the average cost of a hospital admission being estimated at £1500, it can be deduced that such testing is cost efficient for the NHS. Additionally, reducing antibiotic prescribing contributes to antimicrobial stewardship, a concept that is especially important in general practice.
Point-of-care CRP testing therefore offers the potential of financial savings, whilst reducing antibiotic over-prescribing.
815 A person-centred approach to managing pain: bridging mental and physical health
Victoria Tzortziou Brown
Aim To address both the physical and psychological needs of patients with chronic musculoskeletal pain, improve patient related outcomes and facilitate the adoption of healthier lifestyles.
Content of presentation Two innovative community services were systematically developed, piloted and evaluated: a Health Trainers` back pain course incorporating yoga and mindfulness delivered by local health trainers and a Psycho-educational course incorporating a combination of CBT, mindfulness and pain education delivered by the community psychology service.
Relevance/Impact Chronic musculoskeletal pain is common and is the cause of significant health and socio-economic burden. Current service provision is often suboptimal as it fails to adopt a holistic, person-centred approach to management.
Outcomes There was a statistically significant improvement of WHO wellbeing scores of patients who attended the Health Trainers course (pre-course mean score 38 and post-course 55, paired t-test < 0.001). There was a statistically significant improvement of PHQ-9 scores (pre-course mean score 17, post-course 3, paired t-test<0.001), GAD scores (pre-course mean score 13, post-course 10, paired t-test <0.001) and 5D-5L VAS scores (pre-course mean score 43, post-course 53, paired t-test <0.001) for patients who attended the Psycho-education course.Half of the participants in the Health Trainers` course lost an average of 1.7 kg in weight during the 12 weeks` programme.All participants (100%) reported that they would recommend the courses to their family and friends.
Discussion The success of the pilots demonstrates that a holistic approach when caring for people with chronic pain, addressing both mental and physical needs, can result in major improvements across a range of patient related outcomes while empowering people to take control of their condition and improve their lives.
816 COPDPass- patient expertise just a breath away
Background Patient empowerment is a world-wide emerging paradigm. This promises better medical outcomes at lower costs (Chatzimarkakis, J. J Diabetes Sci Technol 2010; 4(6): 1570-73) through patients’ increased understanding of their conditions and active involvement in managing these. Based on personal observations that patients in primary care lack knowledge of aspects surrounding their COPD diagnosis, we set out to create the first mobile App of its kind to address this.
Aim To develop a free of charge App that supports patient involvement in disease management.MethodsDiagnostic and management criteria for COPD were obtained from the Global Initiative for Chronic Obstructive Lung Disease 2015. An interactive framework for the App was set out. It was created using the Ionic framework and was released for the Android platform. Data from an App evaluation survey is in the process of being collected.
Results The App contains interactive data fields for the uploading of personal and physician provided data, educational material, and background information. It allows patients to carry personalised up-to-date information surrounding their diagnosis with them at all times. The App can generate alerts (e.g. flu jab, COPD review). Key feature is the COPD Passport that portrays all parameters at a glance.ConclusionsTo our knowledge, this is the first App supporting patient self-management in COPD whilst containing a patient-clinician interface (COPD Passport).
Benefits are expected for patients (e.g. toolkit to become patient experts, efficient use of appointments, optimal emergency care) and clinicians (data readily available saves time, aids decision making and tailored care provision). Future developments include expansion of the educational materials and communication between primary care computer programmes and the App.
817 Collaborative care and support planning: ready to be a reality
Aim: Introduce delegates to the concept of collaborative care and support planning (CC&SP), and explain its relevance within the changing landscape of the NHS.
Content: The poster will focus on the work of the RCGPs CC&SP programme to date including the implications of the recent (July 2016) College endorsement of care planning as core business of General Practice and its inclusion in GP training.
Relevance/impact: The future landscape of the NHS and primary care is changing; with an increasing ageing population experiencing more multimorbidity and frailty, and overburdened GPs, it is feasible that the service cannot survive in its current form. Primary care needs a more effective way of addressing the bio-psychosocial elements of health, identifying the issues that influence an individual’s health and their likelihood of developing disease. If it doesn’t, the need for secondary care and hospital admissions will continue to rise, which will continue to draw financial resources away from primary care.
Outcomes: An introduction to the concept of person-centred care and CC&SP, as well as a demonstration of its relevance for GPs today. Implications of RCGP endorsement explained. Suggestions of support available for those interested, and next steps for those implementing already.
Discussion: RCGP endorsement of CC&SP as core business for General Practice means there is much discussion to be had by healthcare professionals around what this means and what the next steps are. We are keen to encourage this, and will be available to direct interested parties to appropriate resources and sessions at the Conference.
818 Collaborative care and support planning: creating a movement for change
Aim: Displayed alongside ‘Collaborative care and support planning: ready to be a reality’. Having demonstrated the importance of CC&SP, this poster will describe one method for supporting this movement towards person-centred care; the establishment of a UK-wide network of CC&SP champions.Content: The value of networks within healthcare systems is widely recognised. The poster will focus on establishing the CC&SP network structured around the Health Foundations ‘What makes an effective network’, including why we took this approach. It will explore some successes and challenges faced, including solutions. There will be a focus on shared best practice and resources, collaborative working, collecting an evidence base, and outputs.
Relevance/impact: Having described the changing landscape of the NHS and primary care, healthcare professionals will need to think about how to make the change towards person-centred integrated care and what support is available. The CC&SP network offers an invaluable resource for people seeking information and support, and is an excellent example of ‘early adopters’ leading change.
Outcomes: Allow delegates to reflect on how to create and be part of a movement for change in primary care, and highlight opportunities for support in implementing this way of working.
Discussion: The relevance of person-centred care is evident in the number of associated sessions in the Conference programme. This poster will enable discussion around how to make the first steps, best approaches, and inevitable challenges. We want to encourage this discussion, and will be available to direct interested parties to appropriate resources and sessions at the Conference.
819 A Revolution in Community Pharmacy
Aim My proposal aims to have community pharmacy re-organised around patients’ needs.
Content of presentation Currently, highly trained community pharmacists are paid on their output of dispensed items and for enhanced services. Patients often feel unable to ask pharmacists questions for various reasons, including: privacy; they do not want to go into a cupboard; the pharmacist looking busy behind the dispensary, creating an emotional as well as a physical barrier for the patient. I propose that patients should be given the option of having repeat prescriptions delivered directly to their homes, and home visits by pharmacists. Community pharmacies would still be there for acute dispensing, and patients could still choose to go to the local pharmacy.
Relevance/Impact Home deliveries of repeat prescriptions would make it easier for patients to get their medications and free up pharmacists’ time, enabling them to work in local GP surgeries and to undertake home visits. Annual home visits, perhaps more for people with multiple co-morbidities, would allow pharmacists directly to support and educate patients about their medications and adherence.
Outcomes The key outcome would be getting pharmacists out of their shops and into the community to improve community pharmacy services for patients. Funding would shift to being paid per capita, and using a centralised home delivery service could potentially save costs.
Discussion The proposed model would take pharmacy care right into people’s homes, making life easier for patients, and it could also save money and enhance health outcomes through improved adherence and reduced waste.