Digitally-enhanced medicines optimisation for people with COPD

North Tyneside pharmacy teams are using a digital self-management tool to support patient self-management, The tool also aims to improve the use of rescue packs prescribed to the patients. A chronic obstructive pulmonary disease (COPD) rescue pack is a short course of steroids and antibiotics issued in advance, which a person with COPD keeps at home and uses as part of their exacerbation plan.

Situation

The National Institute for Health and Care Excellence (NICE) recommends prescribing rescue packs for patients with COPD at risk of having an exacerbation, which has resulted in them becoming widely used. There is, however, a big difference between effective self-management and the simple prescription of a rescue pack, and there are concerns that rescue packs can be misused, increasing the risk of resultant complications. Therefore, we need to explore effective self-management strategies to support rescue pack prescription to ensure their safe and proper use.

Aspiration

To improve patient self-management and resultant disease control to reduce the risk of exacerbations.

To ensure that patients respond appropriately to deterioration and only use rescue medications when required.

To ensure that inhaler technique and concordance is optimised to ensure daily pharmacotherapy is optimal.

Solution and impact

The NHS-approved and NICE-endorsed myCOPD app has been designed by clinical experts to support patients in self-managing their condition and enhances clinical teams’ ability to deliver effective care.

Research has shown that the education and rehabilitation tiles within myCOPD can deliver parity of care with face-to-face pulmonary rehabilitation delivery Trooper study (MMH-R01).

A further study has also looked at the impact of introducing myCOPD as part of the discharge bundle post infective exacerbation of COPD. The results found that myCOPD improved exacerbation recovery rates, with strong signals of lower re-exacerbation and readmission rates over 90 days. myCOPD also reduced the number of critical errors in inhaler technique compared to usual care with written self-management RESCUE trial (MMH-R02).

Functionality

myCOPD is a web-based application accessed through almost any device that connects to the internet. It provides access 24/7 to support and enhance any face-to-face care received. The app is listed in the NHS Apps Library.

Capabilities

Using myCOPD can enable services and patients to deliver and access services remotely and support best practice management. Key features of myCOPD include:

  • remote delivery of pulmonary rehabilitation
  • optimisation of inhaler technique
  • clinical self-management plan
  • education delivery
  • symptom monitoring with reference back to self-management plan
  • CAT Score (COPD assessment test)
  • MRC (Medical Research Council) dyspnoea scale
  • medicine use review

Scope

The pharmacy team aims to review patient caseloads across primary care to identify patients with more than three rescue packs in the last year, or who are overusing their short acting beta agonists (SABA). The pharmacy technicians will then look to support the patients to access myCOPD and set goals. These can include completing a daily symptom score or self-management plan, working through the education course, and viewing the inhaler technique videos to see if this leads to improved use of their pharmacotherapy and overall control of the disease.

Find out more

Find out more from the My mhealth website

Key contact

Dr Harry Thirkettle, head of operations for my mhealth

harry.thirkettle@mymhealth.com

Liz Underhill, practice pharmacist, North of England Commissioning Support Unit

eunderhill@nhs.net