EOI: Integrated Partnership Model of Care for COPD

Sydney North Health Network is partnering with the Chronic Disease Rehabilitation Service (CDCRS) at Northern Sydney Local Health District, the University of Sydney and the University of Wollongong to trial a new model of care for people with COPD.

We hope to learn whether physiotherapists and general practitioners (GP) working together can case find and improve the care of people with chronic lung disease (COPD) in the community, in particular increase physical activity levels and referral to pulmonary rehabilitation programs for those who meet the requirements.

The study is being conducted by:

  • Dr Sally Wootton and Mr Stephen Crone, CDCRS, Northern Sydney Local Health District.
  • Associate Professor Sarah Dennis and Dr Zoe McKeough, Discipline of Physiotherapy, University of Sydney.
  • Professor Nick Zwar, Faculty of Medicine, University of Wollongong.

A specialist cardiorespiratory physiotherapist from the CDCRS will be assigned to your general practice to work with you one day per week for approximately nine months. The physiotherapist will assess two groups of patients: adults aged 40 years and older with a diagnosis of COPD and adults aged 40 years and older, with a history of smoking and at high risk for COPD.

The assessment with the physiotherapist will include pre and post bronchodilator spirometry and completion of the Active Australia questionnaire, the Patient Activation Measure (PAM), and the COPD Assessment Test (CAT). The physiotherapist will initiate or update a care plan. They will provide physical activity advice as well as provide an exercise prescription and pedometer to monitor physical activity goals. They may refer the patient to a local pulmonary rehabilitation program if the patient meets the requirement (i.e. any severity of COPD with symptoms). If they are still a smoker they will provide smoking cessation advice and referral if necessary. If the patient is found to have spirometry confirming a new diagnosis of COPD they will be referred to you for further medical management and review.

Patients will come back for two further follow-up assessments with the physiotherapist after one month and three months.  The purpose of these appointments is to monitor their progress with their treatment goals, in particular physical activity goals.

If you are interested in being part of this study, please contact Deborah Pallavicini at Sydney North Health Network and someone from the project team will be in touch and arrange a visit to your practice.

Deborah Pallavicini
E: dpallavicini@snhn.org.au
T: 02 9432 8215