Figures
- FIGURE 1
Hospital admissions and emergency department presentations (without admission) for respiratory illness. Data are presented as mean±sem.
- FIGURE 2
Advanced Lung Disease Service advance care planning activities.
- FIGURE 3
Advanced Lung Disease Service patients' place of death.
Tables
- TABLE 1
Advanced Lung Disease Service key components
1) Respiratory and palliative care offered together, to provide individualised care which addresses the underlying respiratory disease, symptoms and psychosocial issues 2) Disease treatment optimisation including: optimising inhaler therapy and device technique, smoking cessation support, pulmonary rehabilitation referral, and domiciliary oxygen therapy assessment, education and management 3) Comprehensive management of refractory breathlessness, with nonpharmacological strategies (such as breathing techniques, recovery breathing positions, the use of a handheld fan) and opioids as required; individualised written breathlessness plans and written breathlessness resources provided 4) Self-management support including patient and family education regarding disease and symptom management, with provision of written exacerbation action plans 5) Routine discussions regarding goals of care and advance care planning 6) Patient- and family-focused care including extended 1-h consultations, urgent reviews and rapid access (<1 week) for new referrals as needed 7) Specific carer support including facilitating access to respite care and bereavement support 8) Long-term follow-up with continuity of care in clinic and nonabandonment 9) Telephone support and home visits provided by a respiratory nurse consultant 10) Early access to “Hospital in the Home” care to avoid respiratory admissions 11) Respiratory care and service coordination, and integration with other community services, including aged care assessment services 12) Focus on early communication with, and support of, general practitioners and other health professionals, including teleconferences - TABLE 2
Patient characteristics and diagnoses
Patients 171 Male 97 (56.7) Age years (mean (range)) 75.9 (42.8–91.8) Ex-smoker 134 (78.4) Lives alone 45 (26.3) Lives in nursing home 19 (11.1) Primary respiratory diagnosis COPD 142 (83.0) Pulmonary fibrosis 14 (8.9) Bronchiectasis 7 (4.1) Coexisting second respiratory condition 107 (62.6) Comorbidities (mean (range)) 6.8 (0–14) Anxiety 65 (38.0) Depression 51 (29.8) Cardiac disease 119 (69.6) Cardiac comorbidities (mean (range)) 1.5 (0–5) Pulmonary function n=169 FEV1 L (median (IQR)) 0.8 (0.6–1.1) FEV1 % pred (median (IQR)) 41.5 (32.0–55.8) FVC L (median (IQR)) 2.2 (1.7–2.7) FVC % pred (median (IQR)) 83 (65.3–101.8) DLCO (median (IQR)) 8 (6–10) DLCO % pred (median (IQR)) 37.5 (29.0–48.0) 6MWD on air m (median (IQR)) n=163 80 (0–222.5) PaO2 mmHg (median (IQR)) n=115 57.1 (51.1–64.0) PaCO2 mmHg (median (IQR)) n=115 45.0 (39.3–50.9) Domiciliary oxygen use 111 (64.9) mMRC Dyspnoea scale score (median (IQR)) 4 (2–4) mMRC Dyspnoea scale score 1–2 48 (26.9) mMRC Dyspnoea scale score 3–4 123 (73.1) Data are presented as n or n (%), unless otherwise stated. COPD: chronic obstructive pulmonary disease; FEV1: forced expiratory volume in 1 s; IQR: interquartile range; FVC: forced vital capacity; DLCO: diffusing capacity of the lung for carbon monoxide; 6MWD: 6-min walk distance; PaO2: arterial oxygen tension; PaCO2: arterial carbon dioxide tension; mMRC: modified Medical Research Council.
Supplementary Material
N. Smallwood 00102-2017_Smallwood
