Respiratory Disease
Why is Respiratory Disease one of MidCentral DHB’s Health Priority Areas?
Respiratory disease is a priority because it is the third most common cause of death (9%) within MidCentral’s district and many risk factors are preventable. The risk of death from respiratory causes is 45% higher for people residing in socio-economically disadvantaged areas compared to MidCentral overall.
More information about the planning around respiratory disease in availiable in the Respiratory Service Plan.
A group of cyclists biking along the road.
What is a Respiratory Disease?
Respiratory diseases include asthma, pneumonia, emphysema, chronic bronchitis, bronchiectasis, ling cancer and cystic fibrosis. Asthma is more common among children and emphysema is more common among older people. The risk of lung infection is highest for children and older adults.
New Respiratory Initiatives and Services Implemented in the District
MidCentral DHB’s strategies to the address the incidence and impact of respiratory disease:
- Increase investment in promoting healthy lifestyles, particularly focused on smoking cessation
- Increase the access to, and uptake of effective asthma self-management strategies.
- Expand hospital in the home services to provide support to people with chronic obstructive pulmonary disease (COPD) and pneumonia
- Provide psychological support to assist people in the self-management of their respiratory illness
- Develop increased workforce expertise and capacity in respiratory treatment and care
- Work intersectorally with other agencies to address environmental pollution and poor housing issues
- Smoking, obesity, environmental pollutants and poor housing are some of the risk factors associated with respiratory disease.
New Respiratory Initiatives and Services Implemented in the District
Pulmonary Rehabilitation
Community Sleep Apnoea Clinic
Integrated Respiratory Nurse-Led Clinics
Increase Spirometry Access
Pulmonary Rehabilitation
COPD is the second most common cause of admission to Palmerston North hospital.
Pulmonary rehabilitation programmes are an integral part of the long term management for those patients facing the disability and debility associated with long term chronic lung disease. Such programmes aim to enhance the quality of life and should result in decreased utilisation of more costly health care.
Funding has been approved for the progressive provision of pulmonary rehabilitation programmes in Horowhenua/Otaki, Tararua, and Manawatu.
The programmes will run over 40 weeks of each year. Patients are individually admitted into the programme based on appropriate entry criteria. There is a maximum of 10 patients in each programme which comprises two sessions per week for 10 weeks.
Community Sleep Apnoea Clinic
Obstructive sleep apnoea (OSA) syndrome is characterised by excessive daytime sleepiness and irregular breathing at night. The consequences of untreated sleep apnoea include poor concentration, reduced alertness, mood and personality changes, and a reduction in the quality of life.
The community based sleep apnoea service accounts for one of the key initiatives in the Respiratory Service Plan, provides a model of care which integrates primary and secondary services, is supported by a strong international evidence base, and is expected to contribute to the reduction of health inequalities.
Five general practitioners from throughout MidCentral’s district have been trained to undertake assessments of patients suspected of having OSA. The practitioners undertake an evaluation to assess the clinical probability of the patient having OSA by following established guidelines.
This probability will be used in conjunction with the patient’s symptoms and other clinical problems to determine the initial action. This action will be one or a combination of the following:
- Offered a home based study (oximetry or Somte study).
- Referred directly to the MidCentral Health Sleep Clinic (high probability of OSA plus coexisting risk factors).
- Offered advice about behavioural and lifestyle changes and discharged back to original GP.
The service objective is the identification and treatment of patients with sleep apnoea who are most severely affected and at greatest risk, and who will benefit most from treatment. The expected outcomes include the prevention of avoidable hospital admissions, serious morbidity and death.
There is a high quality international evidence base (including Randomised Controlled Trials) which demonstrates that CPAP treatment reduces daytime sleepiness in patients with severe obstructive sleep apnoea. This is an important outcome with respect to driving ability, particularly for occupational drivers such as bus, truck and taxi drivers.
Integrated Respiratory Nurse-Led Clinics
Recruitment is underway for additional physiotherapy and nursing positions for a new respiratory service.
The service will combine MidCentral Health specialist nurse and physiotherapy services integrated with new community nurse and physiotherapy services under the four local PHOs. The aim is to deliberately extend the overall service into those communities identified as disadvantaged in terms of population health equalities.
Access to specialist respiratory services for such people is a significant limiting factor and there are logistical difficulties with present respiratory service staff getting out to the more remote areas, despite some very commendable efforts. This proposal aims to improve access to respiratory services by deploying both nurses and physiotherapists in the respective PHOs.
The MidCentral specialist nurse and physiotherapist teams will work closely with community partners and the Primary Health Care Nursing Development Team to provide a mentoring, oversight and professional development role in addition to their current case work. Extra resource is included in the proposal to accommodate this extension to their role.
The Plan incorporates four overlapping service components designed to target people with chronic respiratory disease, in particular asthma, chronic obstructive pulmonary disease (COPD) and pneumonia.
The four components include:
- Proficient level 3 community based nurses – yet to be employed;
- MidCentral Health specialist respiratory nursing service;
- MidCentral Health specialist respiratory physiotherapy service;
- PHO based community physiotherapists with supporting links to existing primary care services, in particular general practice teams.
Increase Spirometry Access
Spirometry is the most commonly used respiratory function test for assessing respiratory disease worldwide. It is of great value for assessing conditions such as asthma, cystic fibrosis, and COPD.
Offering community based spirometry is another positive move forward for the DHB towards the promotion of primary and secondary integration and providing better access for community based diagnostic tests.
All primary health care professionals planning to provide spirometry will attend education sessions in use of Spirometers. All maintenance and re-calibration work required will be handled centrally by MidCentral Health technicians.
Funding is for the purchase of five spirometry units - one for each of the PHOs and one for the Respiratory Department at MidCentral Health for consistency of calibration. Funding includes an additional 0.2FTE for technician input.
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Last Updated 29/10/2007