Innovations aimed at improving new patient identification, diagnosis, nonpharmacological treatment, supported self-management, and remote monitoring, together with new methods of clinical support could improve outcomes in patients with respiratory disease. The Investigators have developed a model of care incorporating key innovations for patients with asthma, COPD and undifferentiated breathlessness. This service is being implemented within Wessex CCGs. The investigators will assess whether the implementation of the service is effective, and how it can be adjusted, in addition to introducing innovations to assess whether the expected benefits for patients are realised.
A combination of study designs are required to evaluate all aspects of the service: * Participatory action research approach, involving real-time evaluation at each clinic to inform subsequent clinics * Before-and-after study for patient outcomes pre-clinic attendance and post-clinic attendance. * Qualitative methods (interviews, focus groups) Evaluation of the clinic cycles will include consideration of qualitative data from patients, carers and healthcare professionals, in addition to quantitative outcomes for service implementation and patient factors (i.e. uptake of the service and benefits realised in-session), including those in the following areas: * Clinic process * Education and supported self-management * Added value of diagnostic tools (new diagnoses) * Applicability and use of treatment tools and treatment tailoring * Self-monitoring appropriateness and uptake * Balance measures (e.g. increased secondary care traffic) The longer-term impact of the service will be evaluated using clinical and health service outcomes such as: * Hospitalisations for airways disease * perceived disease control (symptom scores etc) * exacerbation frequency * health-related quality of life * Patient Activation Measures (PAM) * Treatments used * Healthcare resource use (primary and secondary care)
Study Type
OBSERVATIONAL
Enrollment
342
The Investigators have developed a model of care incorporating key innovations for patients with asthma, COPD and undifferentiated breathlessness. This service is being implemented within Wessex CCGs.
Portsmouth Hospitals NHS Trust
Portsmouth, United Kingdom
Acceptability of clinic process measured through the collection of qualitative feedback.
Qualitative feedback forms collected at ever clinical encounter, qualitative interviews at 3 months post clinic and HCP focus groups will generate qualitative data. This will be evaluated cyclically to inform changes in the clinic structure.
Time frame: up to 18 months
Number of changes in primary diagnosis or classification of disease severity resulting from a MISSION clinic appointment.
The number of new or changed diagnoses made as a result of a MISSION clinical encounter will be recorded.
Time frame: 18 months
Number of additional co-morbid medical conditions identified from a MISSION clinical encounter.
The number of co-morbid medical conditions identified by the medical team at a MISSION clinic will be recorded
Time frame: 18 months
Frequency of uptake and attendance at the enhanced asthma education programme ESMENA
The number of patients invited to attend ESMENA who accept the invitation will be recorded. Attendance rates over each 3 sessions will be recorded.
Time frame: 18 months
Changes in patients' perceived confidence in self-management before and after MISSION clinics and education sessions measured through questionnaire feedback
Patients will be asked to fill out a baseline questionnaire exploring their confidence in managing their disease and their health behaviours. They will be asked to rate confidence using a Liekrt scale that will be repeated at 3 and 6 months following their clinical or educational encounters.
Time frame: 18 months
Uptake and acceptability of HCP education through the MISSION process
The numbers and grade of HCP who attend MISSION clinics and dedicated education sessions will be recorded. 10% attendees will be asked to participate in focus group interviews which will explore their beliefs around the value and acceptability of these educational opportunities.
Time frame: 18 months
Number of patients where inhaler technique is improved at the first MISSION clinical encounter
Each patient will undergo an assessment of inhaler technique at their first appointment. Where education is required, it will be recorded if that intervention results in improvement.
Time frame: 18 months
Number of referrals to the smoking cessation service embedded in the MISSION clinics that results in a quit attempt
Data will be extracted from the GP record to indicate if a quit attempt is made
Time frame: 18 months
Any change in medication recorded
The number of new, changed or stopped prescriptions will be recorded.
Time frame: 18 months
Number of triggers on remote monitoring that can be managed remotely
The number of patients using the Message Dynamics or Clinitouch remote monitoring systems who trigger a positive response on symptoms or observations where they can be managed via a supported call rather than a GP attendance will be recorded. Any suspected delay in reporting disease deterioration due to the presence of the remote monitoring systems will also be recorded.
Time frame: 18 months
Number of additional secondary care referrals made as a result of the MISSION ABC process.
As a balancing measure, any secondary care referrals made will be recorded and additional costs to the healthcare system calculated.
Time frame: 18 months
Change in disease-specific symptom control questionnaires from baseline to 3 and 6 months
CAT or ACQ will be measured at baseline and then 3 and 6 months to assess changes in symptom control
Time frame: 6 months
Change in the productivity measure WPA from baseline to 3 and 6 months
Each patient will be asked to fill in the WPA at baseline, 3 and 6 months and the answers compared
Time frame: 6 months
Change in the patient activation measure from baseline to 3 and 6 months.
Each patient will be asked to fill in the PAM at baseline, 3 and 6 months and the answers compared
Time frame: 6 months
Changes in unscheduled health care usage per patient in the 12 months before and after MISSION ABC
For each patient the investigators will record their number of exacerbations, unscheduled GP visits, out-of-hours service calls, ED attendances and admissions in the 12 months before and 12 months after the MISSION clinic.
Time frame: 24 months
Acceptability of each innovation measured
MISSION ABC incorporates several innovative diagnosis and treatment solutions: Thorasys oscillometry, Flo-Tone devices, Airsonett laminar airflow, my mHealth online education, Message Dynamics Remote Monitoring, Clinitouch remote monitoring. For each device patients will be asked to give qualitative feedback.
Time frame: 18 months
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