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In order to combat this, the
national outcomes strategy for chronic
obstructive pulmonary disease
(COPD) and asthma (Department
of Health [DH], 2011) provided
recommendations for quality care,
supported by quality standards for
both conditions and establishing
evidence-based guidelines. Similarly,
The National Review of Asthma
Deaths
(Royal College of Physicians,
2014) highlighted issues that may
be adversely affecting asthma
management, including:
i
Forming the correct diagnosis
i
Inappropriate prescribing
of treatment
i
Inadequate asthma reviews
i
Failure to recognise the severity
of symptoms
i
Failure to follow recommended
pathways of care.
But despite these efforts, we still
have some way to go. Although
the results of the national COPD
audit programme (Stone et al, 2014)
of secondary care demonstrated
an overall improvement in care,
an admission to hospital was
highlighted as a crisis in the long-
term management of the patient,
and there is a recommendation that
new models of care should involve
specialist input, covering the whole
treatment pathway.
To improve the diagnosis
and management of people with
respiratory conditions, the question
has to be asked — is integrated
respiratory care the way forward?
If so, what exactly is integrated
care? Simply speaking, it is the
organisation of patient-centred care
RESPIRATORY CARE TODAY
2015,Vol 1, No 1
5
I have been researching how to improve delivery of care for those with
respiratory disease for many years, as well as teaching medical and
nursing students. The introduction and move towards integrated care
has been one of the most significant changes to the NHS over the last
few years. This process is being driven along for a variety of reasons.
Firstly, to improve efficiency and costs and secondly, and probably more
importantly for us, to improve the care that is delivered.
This system-wide change gives us a unique opportunity to realistically
embed patient-centred care, with new innovative ways of interacting with
patients and their families, using systems such as virtual clinics and care
planning conferences. This will help bring care closer to patients and allow them and their families
to be more involved in care. From our recent project with the British Thoracic Society (BTS; www.
brit-thoracic.org.uk/delivery-of-respiratory-care/integrated-care/) we know that many healthcare
professionals are interested in working in this new way to ensure that patients get the right
care at the right time in the right place. Our project looked at one way of delivering care, using
integrated respiratory consultants and how they work in practice now. This type of role can help
bring in expertise from an acute specialist setting to improve services locally (i.e. risk profiling, care
bundles), as well as being a bridge between sectors and helping to provide seamless care. As this
new way of working rolls out, it is important that as well as considering some of the process and
system changes (i.e. budgets, management systems, commissioning and funding), we also consider
important issues such as educating staff at all levels, as well as creating new career pathways to
entice individuals into this new field. This is a really exciting opportunity for everyone to look at
what works in our own practice and see how we can integrate with our colleagues
across all sectors.
Dr Nicola Roberts,
lecturer, Department of Nursing and Community Health, Glasgow Caledonian University
RESPIRATORY CARE MATTERS
i
that involves both health and social
care staff and services, resulting
in an improvement in the quality,
experience and cost-effectiveness of
patient care.
Sounds simple? Not necessarily.
There are several types of
integration:
i
Organisational integration: where
the healthcare organisations
themselves are formally merged
together — the NHS and social
services, for example
i
Service integration: where separate
clinical services are integrated, e.g.
nursing, medical and occupational
therapy and social work
departments working together in a
multidisciplinary team
i
Functional integration: where
non-clinical support and back-