P114 Evaluation of a one-stop respiratory outreach clinic for patients attending a substance misuse service: addressing under-diagnosis and unmet needs; acceptability and impact. (11th November 2022)

• Record Type: Journal Article
• Authors: Monsell, A; Shatta, A; Sathanandan, S; Price, O; Restrick, LJ
• Is Part Of: Thorax. Volume 77(2022)Supplement 1
• Page Start: A141
• Page End: A141
• Publication Date: 2022-11-11
• Subjects: Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thorax-2022-BTSabstracts.249
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Introduction and Objectives: Patients under the care of substance-misuse services commonly smoke drugs and tobacco; both of which increase the risk of respiratory disease. This patient group does not readily access healthcare so goes un-diagnosed and misses out on low-cost high-value respiratory interventions. The aim of this study was to evaluate patient-need, acceptability and impact of a 'one-stop' outreach respiratory clinic offered to high-risk individuals attending a substance-misuse service in North London. Methods: Patients attending substance-misuse services were screened using respiratory case-finding criteria (MRC-breathlessness score >2, smoked drugs and/or tobacco history, and/or oxygen saturation (SaO2 ) <97%). Those meeting criteria were offered a respiratory physician review including spirometry, carbon monoxide (CO) reading, explanation of findings with advice, offer of referral for specialist tobacco dependence treatment (TDT) and summary with recommendations for their GP. Impact was assessed by telephone follow-up. Results: See table 1 . Between September 2020 and May 2022 126/176 (72%) patients screened met criteria. 46/61 (75%) patients invited for review attended. Mean (range) age was 54 years (M=29;F=17). All reported breathlessness (50% MRC > 4). 22/46 (48%) had SaO2 <97% (mean 94; range 88–96)%. Mean (range) FEV1 was 2.49 (0.56–4.35) L, FVC 4.65 (1.56–5.96) L and ratio 0.63 (0.31–0.85). A new diagnosis of COPD was made in 22/46 (48%) patients. 14/46 (30%) had ever received influenza vaccination. 46/46 (100%) had a history of heroin, crack and/or cannabis smoking. All were tobacco dependent with mean (range) 42 (5–120) pack-years. Mean (range) CO was 25 (6–94) ppm. 39/46 (85%) accepted referral for specialist TDT. 28/46 (61%) were contactable for phone follow-up at mean (range) 6 (4–12) months. Following clinic review, 14/28 (50%) reported receiving influenza vaccination; 7/14 for the first time. 11/28 (39%) reported having stopped smoking tobacco; 10 working with TDT specialists. Conclusion: Take-up of the offer of respiratory review was high in patients with respiratory symptoms attending substance-misuse services. This outreach clinic for this hard-to-reach population was found to be high value; 48% of attendees had a new diagnosis of COPD made; 30% of all attendees had influenza vaccination following review and 23% were supported to stop smoking.