Exploring acute COPD care at home in East Kent.
Research type
Research Study
Full title
Acute care at home in Kent for patients with Chronic Obstructive Pulmonary Disease (COPD): an evaluative single case study.
IRAS ID
325342
Contact name
Sally Kendall
Contact email
Sponsor organisation
Kent Community Health NHS Foundation Trust
Duration of Study in the UK
0 years, 7 months, 31 days
Research summary
Summary of Research
Chronic Obstructive Pulmonary Disease (COPD) is a serious respiratory condition that has no cure and was the third leading cause of death worldwide in 2019. Respiratory conditions including COPD affects one in five people in England and are the third biggest causes of death. People with this condition endure long-term breathing and mobility problems and often experience acute exacerbations that lead to hospitalisation where NHS Kent and Medway CCG had the highest number of emergency hospital admissions for COPD with 2,200 in the financial year ending 2021. COPD has a major impact on quality of life and impaired psychological well-being for both the patient and their carers as well as a large cost to the NHS.
The government has put a strategy in place for improving the care of communities which are disadvantaged. This includes working with Integrated Care Systems to identify inequality and references a range of communities that are significant in Kent including ethnic minority groups, coastal communities, and vulnerable migrants. COPD and acute episodes leading to hospital admissions is one priority for improvement.
Community Nursing teams with training are well placed to manage COPD at home but there is room to explore how this could be improved, thus to help those most in need during acute episodes in order to improve access to care and simultaneously avoid or improve the need for admission to hospital. Existing models in East Kent include the specialist respiratory nursing service that offers a home-based service for the very unwell patient, it demonstrates full integration between acute care in East Kent Hospitals, Kent Community Health NHS Foundation Trust and Primary Care. This service has been shown to reduce hospital admissions and cost to the NHS but is not extended to patients who do not meet inclusion criteria.
Summary of Results
1. We prefaced the study with a scoping review of the literature around hospital at home models to support patients experiencing an acute exacerbation of chronic obstructive pulmonary disease (COPD) using key word searches of online databases. A limited number of intervention papers (n=3) and a qualitative paper (n=1) were identified. They showed that there were some promising short-term impact of ‘Hospital at Home’ (HaH) models which showed cost savings via reduced subsequent hospital presentation as well as care costs. These were not seen longer term and was speculated to be attributed to a lack of embedding models into services.
2. Qualitative semi-structured interviews or focus groups were conducted with patients with COPD (n=7), carers of people with COPD (n=2) and community healthcare professionals (n=9). These interviews highlighted a number of potential barriers to the implementation of a HaH from the perspectives of different stakeholders including reservations around increased responsibilities on the carers to provide medical/nursing level care, concerns around existing staffing levels and how a new model could be implemented and staffed as well as beliefs around moving to a HaH model was indicative of a lower standard of care embedded in the stigma around COPD. Potential enablers to a HaH model were also identified across the stakeholder interviews including the positive benefits of COPD patients being supported within the comfort of their own home environment, this was present in all three stakeholder groups.
3. Explore with operational, strategic and commissioning personnel the expectations on delivery, costs and impact on hospital admission of the acute care at home model. This objective proved difficult to meet with some reluctance from personnel to participate. One interview was conducted that yielded some useful data relating to one part of the service (specialist respiratory nursing)
4. Analyse existing data sets such as Hospital Episode Statistics data for patterns of hospital admissions in Kent and associations with acute COPD and other variables such as ethnicity, place of living, age. These data were collected from the Public Health Observatory for Kent and Medway and from the RIO data held within the Trust. They yielded interesting and important findings that suggest the services for COPD in Kent vary in both input from different service models and output in hospital admissions and length of stay. The data were insufficiently strong to be able to undertake a full economic analysis but provide parameters for future work and recommendations for providing an equitable service across Kent.
5. Identify the gaps and parameters necessary to prepare a wider grant application to NIHR HS&DR that will use these data to develop a logic model to test the hypothesis that acute care at home through integrated community nursing can improve the patient experience, reduce hospital admissions and cost and increase quality of care. There is sufficient learning from this study to provide the development of a logic model with public engagement for further refinement and testing in a future study, with particular focus on recruitment of participant numbers, alignment of NHS and PHO data with HES data, ensuring data meet criteria for economic analysis and greater involvement of informal carers and the public.
REC name
West of Scotland REC 5
REC reference
23/WS/0074
Date of REC Opinion
31 May 2023
REC opinion
Further Information Favourable Opinion