How a weather forecasting service can reduce COPD hospital admissions

There’s a strong link between the weather and health, especially during cold winters when there are significant increases of mortality and morbidity. High levels of circulating infections amplify these effects. The impact is particularly marked among patients with Chronic Obstructive Pulmonary Disease (COPD), who have a significantly increased risk of ill-health and hospitalisation during the winter months [1, 4].

Healthy Outlook® is a forecast alert service from the Met Office that helps people with COPD cope with these high risk periods and stay well and out of hospital.

Healthy Outlook® works by giving COPD patients interactive alerts advising them on how to manage their symptoms better during high risk periods. Information about their responses to the interactive alerts is fed back to GP practice staff. The service empowers patients to better manage their health and enables healthcare professionals to take proactive measures to help keep people well.

Healthy Outlook® offers patients year-round protection and is a recommended case study in the QIPP (Quality, Innovation, Productivity and Prevention) programme. The service offers considerable potential cost savings, for example:

• case studies with PCT customers have shown a consistent 20 per cent [2] reduction in hospital admissions while some PCTs have experienced even bigger reductions.
• This level of hospital admission reduction would equal a £5,000 [3] cash saving for a practice with 10,000 patients.

The benefits of the service to the NHS and the patients have been established through a range of evaluations over several years. These include the following elements.

Randomised control trial

Seventy-nine patients in Devon were selected to participate in a four-month randomised control trial [4]. All were given Met Office Healthy Outlook® patient packs and 40 were randomly allocated to receive the alert calls. The aim of the randomised control trial was to assess the effect of the service and its ability to predict periods of increased risk.

The results showed that 62 per cent of exacerbations were within 14 days of an alert telephone call. The study also suggested that there were reductions in the frequency, severity and duration of exacerbations for those receiving the alerts but these effects were not statistically significant. This was probably due to the size of the trial, lower than expected exacerbation rates and the fact that there were increased levels of contact with the patients in both groups.

Patient survey

To determine patient perception of Healthy Outlook® a cross-sectional questionnaire survey [5] of 3,288 service users was conducted. 85 per cent of respondents reported at least one exacerbation during the study period and 7.5 per cent had been admitted to hospital on one occasion or more.

The survey showed that 88 per cent of people found the automated call useful and 96 per cent found the information in the patient pack useful. There is also evidence that the service encouraged people to be pro-active in the management of their COPD, with 36 per cent of people stating that they sought a repeat prescription in response to a call.

Bath and NE Somerset PCT evaluation

There have been a number of PCT led service evaluations of Healthy Outlook. Here, the service was piloted with 11 practices who recruited 41 per cent of their COPD patients. Their aim was to reduce hospital admissions for COPD patients in the winter.

The results of the pilot were very promising. Practices using the service experienced a 51 per cent decrease in COPD related emergency hospital admissions, while practices not taking part had a 1 per cent increase in the same admissions over the same period.

The pilot demonstrated that Healthy Outlook® has a positive impact on the health and wellbeing of COPD patients, as well as bringing about substantial financial savings for the NHS.

“This reduction equates to 94 emergency spells and a potential saving of £235,000.”

Karen Grant, Commissioner for COPD & Diabetes, Bath and North Somerset PCT

Bath and NE Somerset PCT continue to use the service to help keep people with COPD well during the winter. The Healthy Outlook service can be commissioned by all primary care organisations.

If you are interested in understanding more about how the service can benefit you and your patients please contact the Met Office Health team.

Footnotes

1. Bryden, C., Bird, W., Halpin, D.M.G., Levy, M.L. and Titley, H.A., 2009: Stratification of chronic obstructive pulmonary disease (COPD) patients by previous hospital admissions as a predictor for risk of future admission. Respiratory Medicine, 103.

2. Based on a 40 per cent uptake of the service from Met Office and NHS customer service evaluations

3. Potential savings based on known assumptions

4. Halpin DMG, Laing-Morton T, Spedding S, et al. A randomised controlled trial of the effect of automated interactive calling combined with a health risk forecast on frequency and severity of exacerbations of COPD assessed clinically and using EXACT PRO. Prim Care Respir J 2011;20:324-31

5. Chalder, M., Halpin, D.M.G , Laing-Morton,T., Levy, M.L., Marno, P., and Sachon, P. (2010). Can a health forecasting service offer COPD patients a novel way to manage their condition? J Health Serv Res Policy, July 2010 vol. 15 no. 3 150-155