COPD Support Service brings care closer to home

WA Primary Healthy Alliance is proud to commission Silverchain and Asthma WA to deliver a collaborative service for non-oxygen dependent chronic obstructive pulmonary disease (COPD) patients discharged from hospitals across Perth.

Through a combination of supported discharge and community-based care, the COPD service connects patients with primary care, including general practice, and aims to reduce unplanned hospital admissions by providing a safety net for patients to receive effective care, closer to home.

Patients referred from eight metropolitan hospitals (Armadale Hospital, Fiona Stanley Hospital, Joondalup Health Campus Peel Health Campus, Rockingham General Hospital, Royal Perth Hospital, Sir Charles Gairdner Hospital, and St John of God – Midland) are provided with clinical care coordination through Silverchain’s COPD Supported Discharge Service for up to three weeks after being discharged from hospital.

Each patient receives a telephone consultation within a week of discharge, followed by a home visit. Patients are supported with their hospital discharge plan, with a focus on medications, pulmonary rehabilitation, managing exacerbations and links  to other community services if required.

Silverchain Director Clinical Operations, Sharon Hearns, said they are pleased to be able to support patients with the management of their COPD when returning home after a hospital admission.

“The program provides both face to face and virtual visits with a strong focus on education.”

“Patients are often unsure on what they need to do to stay well. The provision of a COPD Action Plan at the time of discharge is the cornerstone to building a client’s confidence in managing their COPD.

“GPs also play a vital role by continuing to review and update these individualised plans with their patients.”

Asthma WA’s Respiratory Health Team provides further COPD education and support for up to six months. This includes smoking cessation, inhaler device techniques, vaccinations, maintaining an active lifestyle and eating well, as well as using their COPD Action Plan to enable self-management of their condition in conjunction with their GP.

“Asthma WA has been supporting people living with COPD since the regional Asthma COPD Telehealth Service commenced in 2016. Our team of Respiratory Health Nurses work with the patient to optimise their respiratory health and assist them live well with COPD.”

“We are happy to be able to continue providing clinical support, coaching and expertise to COPD patients living in the Perth community, through this program.”

– Rael Rivers, Learning and Development Manager, Asthma WA.

For more information on the management of COPD, and education resources available to health professionals and COPD patients, visit HealthPathways WA.