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Table 2 Deficiencies identified and strategies implemented

From: Chronic Obstructive Pulmonary Disease (COPD) management in the community: how could primary care team contribute?

Areas of deficiencies Strategies implemented
Policy
 Lack of a responsible team Set up of COPD audit Working Group with members from both doctors and nurse. Appointment of one doctor and one nurse from the working group as the audit coordinator.
 Lack of regular review to monitor the COPD management performance Quarterly review policy to monitor the process
 Lack of collaboration with SOPDs Collaborate with Respiratory Medicine Team, Kowloon Hospital on handling severe COPD cases and download mechanism for stable COPD cases.
Practice
 Lack of COPD registry COPD case registry has been retrieved from CMS and has been updated by the working group quarterly
 Lack of guideline or protocol Adopt standard guidelines, development of protocol and structural COPD assessment form
 Lack of aligned workflow The workflow of managing COPD cases were streamlined across all 13 GOPCs in KCC.
 Lack of spirometry machine Purchased 5 more Spirobank machine to cater for the service demand in local GOPCs.
 Lack of drugs for COPD care, such as LAMA. Newly introduced LAMA to Family Medicine Specialist Clinic in 2018.
Staff
 Lack of continuous education and training Improvement on education and training through workshops, clinical meetings and journal clubs.
 Lack of team work Sharing of workload among staffs of all ranks, including doctors, nurses, clerks, allied health workers such as physiotherapist, occupational therapist and dietitian.
 Standardized COPD management workflow All COPD patients were managed according to the grouping based on the latest GOLD guideline.
 Lack of feedback Quarterly to biannually review on the progress of the audit, deficiencies are tackled promptly.
Patient
 Lack of awareness and knowledge and/or lack of motivation on smoking cessation Improve patient’s awareness and knowledge by regular health talks and nurse counselling.