Abstract

Background: Inclusion Health provides GP services to the homeless population within the city of Leicester. Currently, the prevalence of asthma and COPD are below expected for this patient group.

Aims: The aim of the project is to identify undiagnosed airway disease. To proactively optimise patients to reduce morbidity and mortality through early diagnosis and management.

Methods: The project was funded by NHS England, which was used to buy a spirometer and for clinic time. Patients were identified through text message invites, after seeing a clinician, or following screening sessions at local services using FEV/FV6 readings. Appointments involved seeing the nurse for spirometry, followed by a GP review to interpret the results in the context of the patient’s history. Patients were then managed accordingly with treatment, reassurance, lifestyle changes, or referrals for further investigations. Any patients where there has been diagnostic uncertainty were discussed at a monthly MDT with a respiratory consultant.

Outcomes: 160 patient records have been reviewed. From this, 26 were screened using the FEV/FV6; 12 of those were invited for full spirometry. There have been 32 spirometry clinics; 80 patients have attended. 17/89 were given a new diagnosis of airway disease. 21 out of 48 patients who had an existing diagnosis had their treatment modified. The age range of those with an existing or new diagnosis of COPD was 26 - 76. Out of the total population, 71 had active or historic substance misuse. 70% smoke, and 17 patients have been referred to smoking cessation. 32 patients have been referred to pulmonary rehabilitation. 28 patients were discussed at MDT with further input on management.

Conclusions: In this patient group, there is a high prevalence of substance misuse and smoking, as well as poor living conditions, which increases the risk of airway disease. Patients have been diagnosed and had management optimised appropriately with the support of an MDT. There have been challenges with patient engagement and a high volume of patients who do not attend. Outreach clinics and an MDT approach help to reach these patients to improve engagement and health outcomes.