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COPD ‘high users’ of A&E most likely to be admitted to hospital

COPD and bronchiectasis are the most common conditions resulting in high intensity users (HIUs) of A&E being admitted to hospital, reveals an analysis of NHS hospital data.

The report by the healthcare analysis company, Dr Foster, found that the proportion of so called HIUs admitted with a diagnosis of COPD or bronchiectasis (more than 6% of admissions) was more than twice as high as non-HIUs (3% of admissions).

The study shows that the majority of HIUs (70%) live in the most deprived areas of England and that smoking, is one of the key factors playing an important role in frequent A&E use.

The report says this group of patient’s needs are not being met.

Recommendations for change include:

  • Health and care organisations should work with paramedics and A&E staff to identify HIUs of services and their primary reasons for attendance.
  • Commissioners and health and care organisations in local areas should conduct population segmentation analysis to understand the characteristics of the HIUs and where they are coming from and enable integrated services to target resources at particular cohorts of patients.
  • Integrated care systems should ensure that local health services are coordinated to enable patients to successfully manage their own long-term health needs in the community.
  • Health and care organisations should work with HIUs on a one-to-one basis to determine their needs, directing them to other health and care services as appropriate

PCRS Executive Chair Dr Noel Baxter says: “PCRS members will know well a small cohort of people in their practice or caseload who more often than others call 999, attend ED and sometimes get admitted. We also know the factors that matter in why this happens - loneliness, tobacco, alcohol, mental illness and that the interventions to help this problems exist but are either less resourced or less well utilised.

“This report shows that it is chronic respiratory disease that often becomes the coded reason for attendance and admission. To really make a difference optimal respiratory care is needed but this will not have any impact without us all systematically, and in an integrated way, making a real effort to support people with these co-factors that make the respiratory problem hard to handle.”

A new PCRS draft pragmatic Guide to the Diagnosis and Management of Tobacco Dependency can be used by primary and community care clinicians to support their patients to stop smoking.

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