Optimum Patient Care offers a FREE respiratory quality improvement programme for patients with asthma and COPD, designed to equip primary care practitioners with the necessary tools and data to drive better clinical outcomes.
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Optimum Patient Care offers a full research support model designed to equip all primary care practitioners with the support required to successfully deliver research that makes a difference to patients.
Optimum Patient Care (OPC) is committed to making a difference to patients. We provide free and annual comprehensive quality improvement service to help general practices manage patients with Asthma and Chronic Obstructive Pulmonary Disease (COPD).
OPC has been established for over 14 years and continues to support primary care management of chronic diseases in the UK and across the world. Our Quality Improvement Programme encourages and enables GPs to:
- Reflect and add clarity to their data and patterns of care
- Identify those patients with high priority needs & improve patient care
- Compare with other GP’s & national/international guidelines
- Research using a unique data source and contribute to cutting edge science
- Learn with input from world leading experts during local educational workshops
We appreciate the overload associated with daily clinical practice – the pressures of consulting, demands of administration and accreditation. OPC is here to help by adding clarity to your clinical data – making it easier for you to interpret and act upon, by showing you the gaps in your clinical data, where you could improve, which patients you need to prioritise and what you need to reflect on.
We allow you to easily and quickly identify patients for recall or questionnaire level review who may be undertreated, in need of review or potentially at risk. In the UK, this methodology has been shown to lead to a 20% reduction in exacerbations for asthma patients compared to control GP practices (not partaking in the service)
We present your clinical data clearly and succinctly based on clinical parameters that you set, in the context of your practice, guidelines and the needs of your patients along with a comparison to national performance with the Optimum Patient Care Research Database (OPCRD). Data can be customised by a range of variables including patient demographics, diagnoses, prescribing patterns, pathology results and risk-factor levels.
We are committed to bringing research to primary care. Advocating for data generated from experience, with routine medical care in electronic health records (e.g. clinical management in primary/secondary care databases) or national registries (e.g. birth or cancer registries). Ideally, evidence-based good clinical practice relies on a combination of clinical experience (both personal and published real-world data) and experimental (clinical) research implemented. In the UK, OPC has published over 70 papers from the OPCRD.
We believe that clinical audit and research provides an opportunity to deliver evidence based and data driven educational programmes that make a difference to clinical practice. Our educational programmes amalgamate research findings from primary care with clinical practice to provide high quality education to health care professionals.
Anonymised data is gathered from practice clinical systems and combined with data gathered from asthma and COPD questionnaires returned by patients. All data collected for review is pseudonymised at the practice, so no patient identifiable information leaves the practice in accordance with NHS Information Governance and Data Protection laws. A bespoke data analysis is then conducted, in accordance with national guidelines and world renowned expert advisors.
Patients, practices and Clinical Commissioning Groups (CCG) will benefit from quality improvement reports:
- Targeted prioritisation of patient care (identification of your most at risk patients)
- Improved guideline based decision making
- Improved achievement of QOF targets
- Reduced hospitalisations
- Increased appropriate prescribing
- Identification of clinical practice needs which enable targeted initiatives
- Improvements in patient reported quality of life and self-management confidence
We can offer free questionnaires delivered to patients in order to attain information on patient reported outcomes for enhanced and meaningful reporting. Patient questionnaires are dispatched through practice models, contacting patients enabling them to complete their questionnaires online. Patients may also complete their questionnaires online.
The three questionnaires we currently provide are:
The patient questionnaires are anonymised and have no patient identifiable information. Each patient questionnaire has a unique bar code which allows us to link it to the correct practice. It also enables the questionnaire data to be incorporated into your reports. The questionnaire data including those attained online, is then incorporated into both your tailored practice reports and patient level reports. The anonymised questionnaire data forms part of our quality improvement programme and research database and may be used for academic research to improve and advance respiratory care.
Practices are provided with annual tailored child asthma reports, adult asthma reports and COPD reports. The reports are provided both in hard-copy and electronically. The reports are specific to each practice and outcome measures are compared with that of the overall OPC Quality Improvement Database.
This enables a practice to evaluate its performance against an average practice in our service. The reports enable a practice to target patients in need of review and intervention to optimise their care. They also help a practice to meet QoF targets and guideline recommendations for best practice. Subsequent annual reports allow a practice to track its progress and improvements from year to year.
Practice reports cover extensive aspects of Asthma & COPD care including, but not limited to:
- Diagnosis and potentially undiagnosed patients
- Patient demographics (age, co-morbidities and smoking status)
- Disease control and severity status
- Patient risk stratification and exacerbations
- Adherence and concordance with therapy
- Patient reviews and self-management plans
- Management and therapy recommendations based on guidelines
- Focus areas for improvement – if requested by your practice
Example practice reports can be downloaded below.
We recognise that change can only happen at a patient level. As such, we provide practices with individual patient reports for Asthma and COPD. These reports are accessible on practice computers via our bespoke Optimum Patient Care Tools software. Along with receiving a user-guide on how to use Optimum Patient Care Tools, our service team will visit your practice to provide support on accessing your patient level reports and using our tools.
Individual patient reports support clinicians with face-to-face patient consultations. They help identify high-risk patients and other specific patient groups for review and intervention to optimise their care. Each patient has a personalised feedback section which can be provided to them as a self-management plan which is based on OPC researchers, epidemiologists and national guidelines. Patient reports cover extensive aspects of Asthma & COPD care including, but not limited to:
- Individual patient summary
- Summary of patient questionnaire response
- Identification of high risk patients
- Patients associated with recommendations in practice reports
- Personalised feedback for patients (self-management plan)
- Disease symptoms and control status
- Co-morbidities and smoking status
- Therapy status and overview
- Tools for referral to respiratory specialist
Standard CCG or health board report:
Our standard CCG reports provide practice level review of the key aspects of the disease and patient management, using data from member practices of the CCG. It includes QOF target and guideline related review and recommendations for improving patient care, patient outcomes, and quality of health services. The CCG or health board may specify key focus areas for reporting. The reports may include patient reported outcomes if patient questionnaires have been implemented across the locality or for selected practices. Please see our questionnaire service for more information on patient questionnaires. The reports are provided at no cost, annually.
Bespoke CCG or health board report:
Our bespoke CCG reports are aimed at providing CCGs and health boards a detailed evaluation and expert recommendations on chosen disease area(s), for quality or patient care improvement using local data. The reports include analysis of practice level data collected from member practices in combination with other publicly available data and hospital data (if provided by the CCG/health board).
The reports include expert review and best-practices recommendations. Bespoke CCG reports are suitable for evaluation of patient outcomes, local healthcare initiatives, targeted quality improvement, where detailed statistical and clinically guided analysis is required. Bespoke reports are also suitable for initiatives which require publication. Bespoke reports are provided at cost based on specific data and analysis requirements. Please contact our service team for further details of our bespoke reporting service.
Benefits for your practice
- We provide an epidemiological summary of your clinic statistics for free
- The report identifies non-adherence to COPD or asthma management plans to clinicians
- Discussion with an OPC epidemiologist enables the clinic to create a clinic-specific plan to reduce unscheduled care and de-escalate treatment.
Benefits for GPs
- Audits that can be used for annual appraisals and re-validation
- Aids asthma and COPD consultation, improving quality and speed of information delivery in consultation/review
- Aids treatment pathway decision making
- Education directly reflecting your own patients
Benefits for patients
- Diagnosing potentially undiagnosed patients, for early intervention
- Improving patient involvement in care through patient questionnaires
- Self-management plans provide patients with a clear understanding of disease control to help monitor symptoms and better manage their condition and treatment
- Health benefits for patients e.g. avoidance of side effects through discontinuation of inappropriate treatments
- Opportunities for patients to participate in research.