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Managing complex respiratory patients in the community: an evaluation of a pilot integrated respiratory care service
  1. K Gillett1,
  2. K Lippiett1,
  3. C Astles1,
  4. J Longstaff2,
  5. R Orlando3,
  6. S X Lin3,
  7. A Powell4,
  8. C Roberts2,
  9. A J Chauhan2,
  10. M Thomas1,5 and
  11. T M Wilkinson1,6
  1. 1National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Wessex, Respiratory Theme, Southampton, UK
  2. 2Wessex Academic Health Sciences Network (AHSN), Portsmouth, UK
  3. 3National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Wessex, Methodological Hub, Southampton, UK
  4. 4West Hampshire Clinical Commissioning Group (CCG), Eastleigh, UK
  5. 5Department of Primary Care and Populations Sciences, University of Southampton, Southampton, UK
  6. 6Department of Clinical and Experimental Sciences, University of Southampton, Southampton, UK
  1. Correspondence to Dr Tom Wilkinson; t.wilkinson{at}


Introduction In the UK, there is significant variation in respiratory care and outcomes. An integrated approach to the management of high-risk respiratory patients, incorporating specialist and primary care teams' expertise, is the basis for new integrated respiratory services designed to reduce this variation; however, this model needs evaluating.

Methods To evaluate an integrated service managing high-risk respiratory patients, electronic searches for patients with asthma and chronic obstructive pulmonary disease at risk of poor outcomes were performed in two general practitioner (GP) practices in a local service-development initiative. Patients were reviewed at joint clinics by primary and secondary care professionals. GPs also nominated patients for inclusion. Reviews were delivered to best standards of care including assessments of diagnosis, control, spirometry, self-management, education, medication, inhaler technique and smoking cessation support. Follow-up of routine clinical data collected at 9-months postclinic were compared with seasonally matched 9-months prior to integrated review.

Results 82 patients were identified, 55 attended. 13 (23.6%) had their primary diagnosis changed. In comparison with the seasonally adjusted baseline period, in the 9-month follow-up there was an increase in inhaled corticosteroid prescriptions of 23.3%, a reduction in short-acting β2-agonist prescription of 33.3%, a reduction in acute respiratory exacerbations of 67.6%, in unscheduled GP surgery visits of 53.3% and acute respiratory hospital admissions reduced from 3 to 0. Only 4 patients (7.3%) required referral to secondary care. Health economic evaluation showed respiratory-related costs per patient reduced by £231.86.

Conclusions Patients with respiratory disease in this region at risk of suboptimal outcomes identified proactively and managed by an integrated team improved outcomes without the need for hospital referral.

  • COPD Exacerbations
  • Asthma Guidelines
  • Health Economist

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  • KG and KL contributed equally to this work.

  • Contributors KG, KL, JL, CA, CR, MT and TMW conducted the clinics. TMW, MT, KL and AJC helped develop the clinical model. KG and KL collected and analysed the data and wrote the first draft of the paper. SXL provided the statistical analysis and RO conducted the health economic analysis. All authors contributed to subsequent drafts of the paper and approved the final draft. TMW is the guarantor.

  • Funding This paper presents independent research by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Wessex (NIHR CLAHRC Wessex). CLAHRC Wessex acknowledge the participation and resources of our partner organisations. Further details can be found at and

  • Disclaimer The views and opinions expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Access to data can be requested from the corresponding author.

  • Ethics approval The pilot was registered with the WHCCG as a Quality Improvement project and consultation with the Health Research Authority confirmed the project to qualify as a service evaluation.