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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.