Integrated care model between pneumology and primary care: Impact in respiratory diseases control

Introduction A new model of integrated care was established in our hospital since 2008, in which hospital specialists attend patients in different primary care centers. We assessed the impact of this model in the respiratory diseases management. Methods Retrospective, observational study comparing 2 care models in the same cohort of patients: conventional (prior model of care by pulmonologists not integrated into primary care teams) and integrated. Different clinical outcomes were analyzed in relation to the management of respiratory diseases. Results We evaluated 545 patients consecutively attended during a period of 6 months, in five primary care centers. The diagnoses that were established after the start of the new model were: COPD (30 %), bronchial asthma (32%), OSAS (7%), bronchiectasis (15 %), chronic cough (1%) and others (25%). The number of registered spirometries increased after the beginning of the new care model (19 % to 68 %, p < 0.001). A change in diagnoses and treatments occurred in 21% and 49% of cases respectively after initiating the new model. After assessing consultations for exacerbations in a period of 2 years before and after the application of the new model , a significant overall reduction in the number of consultations for exacerbation per patient was observed: 1.07 ± 1.40 to 0.88 ± 1.25 (p=0.001). Conclusions The implementation of a respiratory care model integrated into primary care improved the follow up of these patients by reducing the overall number of visits for exacerbations, possibly due to the optimization of the diagnosis and treatment. Funded by: Atencio Integral de Salut de Barcelona Esquerra.