Authors (including presenting author) :
Ng SW(1), Choi MW(2), Lam CK(2), Lee CL(2), Hung MMI(2), Chan SE(2), Tsui M(2), Cheng SL(2), Tsang WY (2), Lai YKA (3), Cheung PS (2)
Affiliation :
(1) Nursing Services Division, United Christian Hospital (2) Department of Medicine and Geriatrics, United Christian Hospital (3) School of Nursing and Health Sciences, Hong Kong Metropolitan University
Keyword 2: :
Nurse Clinic
Keyword 3: :
Bundle Care for COPD
Keyword 4: :
Self-management
Introduction :
Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of hospitalization. In Hong Kong, COPD admissions are frequent, driven by factors like prior exacerbations, comorbidities, and poor care continuity. To address this, an Integrated Medical Nurse Clinic for COPD (IMSN-COPD) was established in late 2022 to provide coordinated and patient-centered care.
Objectives :
This study aims to evaluate the effectiveness on key service outcomes.
Methodology :
A retrospective service evaluation was conducted. The intervention was a comprehensive nurse-led bundle of care including disease education, inhaler technique review, self-management action plans, smoking cessation support, pulmonary rehabilitation referral, and vaccination promotion. Outcomes for a cohort of 68 patients enrolled between August 2023 and February 2024 were analyzed, comparing equal nine-month periods before and after enrollment. Measures included inhaler technique scores (via standardized checklists), healthcare utilization (ED attendances and admissions for COPD). The influenza vaccination rates and timeliness for the year of 2023/24, and latest patient satisfaction of the year 2025 were also evaluated respectively.
Result & Outcome :
Results: Patients were predominantly male (97%), ex-smokers (73.5%), with a mean age of 76.7 years. Inhaler technique improved significantly for Dry Powder Inhalers (64.6% to 81.9%, p< 0.01) and pressurized Metered-Dose Inhalers (52.1% to 65.7%, p< 0.05). Healthcare utilization reduced: mean Emergency Department attendances per patient fell from 1.25 to 0.75 (p≤0.05) and hospital admissions from 1.04 to 0.69 (p< 0.05). Post-clinic influenza vaccination rates surpassed community baselines (e.g., 78.7% vs. 51.5% for age ≥65). The average time from the launch of Governmental Vaccination Program to vaccination date decreased by 27.08%, from 48 to 35 days. Patient satisfaction was exceptionally high (99%). The numbers of referrals to Pulmonary Rehabilitation Program reached historical high of 318 cases for the year of 2024/25. Conclusion: The integrated nurse-led COPD clinic model was associated with significant improvements in inhaler technique, reduced hospital-based healthcare utilization, and enhanced preventive care uptake. The findings support the expansion of such specialist nursing roles within multidisciplinary models to improve COPD outcomes.
