Sean, can you tell us a bit about your work with the Elective Care Respiratory Programme in relation to its focus on optimising chronic cough management across the patient pathway. What steps you are taking to improve patient access and outcomes in cough?
Chronic cough is very common with a prevalence estimated at around 5%, but the true number of cough patients may be unknown as coding can be inconsistent.
We hope that the project will address some of the barriers and facilitate engagement with local SLT, physiotherapy and ENT services to develop ways of working that will start to formalise and streamline cough pathways for patient benefit.
Patients suffer unpleasant symptoms and often see their GP, take medication, and may get referred on to secondary care all of which puts pressure on the health service. The management of chronic cough could often be improved.
The Elective Care Respiratory Pathways programme is a great example of implementing guidelines into real world clinical practice. The British Thoracic Society (BTS) has been very supportive of the field in the last few years. We have been able to put in a robust evidence-based framework to support delivering care through the BTS Clinical Statement on Chronic Cough in Adults and more recently the BTS Quality Standards for Chronic Cough in Adults, which is currently in development.
We have worked with trusts to implement cough pathways based on the BTS statement that are 'end-to-end' i.e. cover primary and secondary care. The emphasis has been on doing the simple things well. We have encouraged trusts to look at developing access to non-pharmacological treatments for cough. There have been several spin-off projects including the development of 'advice and guidance' materials, a project looking at neighbourhood cough pathways (CLEAR) and the development of a cough bundle for community diagnostic centres.
Claire, with the scope of this project, it aims to have a wide impact on cough treatment and care. What are you hoping to achieve as part of the project, and what are the tools you expect to create throughout your work here?
Limited access to speech and language therapy was identified as a barrier to delivering non-pharmacological intervention for chronic cough. Through the project, we have worked with trusts to identify some practical solutions, such as using virtual models of care, multi-disciplinary clinics and respiratory physiotherapist colleagues delivering the cough control aspect of the intervention, as well as pilot or trial periods with a view to audit the impact.
We hope that the project will address some of the barriers and facilitate engagement with local SLT, physiotherapy and ENT services to develop ways of working that will start to formalise and streamline cough pathways for patient benefit.
The creation of patient information resources as part of this work will facilitate early access to information for patients to gain an insight into chronic cough and to start to manage their symptoms. This, combined with the toolkit for Trusts will achieve awareness of, and earlier access to non-pharmacological management of chronic cough.
Not long ago, you were both guests on our podcast with Professor Robin Condliffe, where you discussed recent developments in treatment and resources that are being created. For those working in respiratory healthcare who wish to start implementing changes to their work today, where would you recommend they find more information?
A good place to start is the British Thoracic Society where you can access the BTS Clinical Statement on Chronic Cough in Adults and later in the year the Quality Standards for Chronic Cough in Adults will be published.
The pathways are summarised in an interactive form on the Health Innovation Oxford & Thames Valley website with both primary and secondary care pathways, self-management resources to support patients and a toolkit to support implementation of the pathways in practice.
Other patient facing online resources include;