Underdiagnosis of respiratory diseases during an economic downturn and the need for spirometry as a screening test

Kotrogianni, Filio; Malli, Foteini; Gourgoulianis, Konstantinos

doi:10.1590/s1806-37132013000200021

Cited by 5 publications

(8 citation statements)

References 2 publications

(1 reference statement)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Studies focusing on Greek primary healthcare settings reveal that COPD is mainly undiagnosed [33,[38][39][40][41]90]. Ideally, approaches to achieve the goal of early diagnosis in COPD need a major overhaul, and a culture change is required in primary-care settings.…”

Section: Secondary Prevention Of Copd In the Years Of Economic Crisismentioning

confidence: 99%

“…Ideally, approaches to achieve the goal of early diagnosis in COPD need a major overhaul, and a culture change is required in primary-care settings. For this reason, a higher index of suspicion, as well as wider use of spirometry for diagnosis, are proposed [33,[38][39][40][41][89][90][91]. A study conducted at the beginning of the economic recession revealed major shortages in rural primary healthcare equipment; only 4.6% of rural doctors had spirometers available for clinical use [91].…”

Section: Secondary Prevention Of Copd In the Years Of Economic Crisismentioning

confidence: 99%

“…A proposed explanation for this geographic variation in COPD rates is the limited access to spirometry in rural areas of Greece, which is strongly evident before and after the crisis [33]. It is well documented that in primary healthcare settings in Greece there are a lack of specialised pulmonologists to perform spirometry, as well as a lack of training and feedback in diagnostic spirometry for general practitioners, both of which are major barriers to spirometry use [38][39][40][41]. Thus, the percentage of undiagnosed patients in primary healthcare settings is estimated to be very high, both pre- [33,39] and post-crisis [38,40,41].…”

Section: Introductionmentioning

confidence: 99%

“…It is well documented that in primary healthcare settings in Greece there are a lack of specialised pulmonologists to perform spirometry, as well as a lack of training and feedback in diagnostic spirometry for general practitioners, both of which are major barriers to spirometry use [38][39][40][41]. Thus, the percentage of undiagnosed patients in primary healthcare settings is estimated to be very high, both pre- [33,39] and post-crisis [38,40,41]. Notably, the study of SPYRATOS et al [38] reported that 52.6% of COPD cases remained undiagnosed.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Impact of the financial crisis on COPD burden: Greece as a case study

et al. 2018

View full text Add to dashboard Cite

Poverty and low socioeconomic status have been associated with chronic obstructive pulmonary disease (COPD). The current financial crisis has forced millions back into poverty. Greece is one of the countries hit the hardest, and is in the middle of a deep ongoing collapse. There have been early reports stating the apparent effects of the Greek downturn on respiratory health. This review summarises the overall impact of the financial crisis on COPD burden throughout the period of economic downturn by analysing the case study of Greece. In all levels of the healthcare system, current economic restrictions have reduced the capacity to prevent, diagnose and treat COPD in parallel with current higher detection rates of COPD. Remarkably, expenditure on healthcare has been reduced by >25%, resulting in major healthcare equipment shortages. Lower wages (by up to 20%) and higher co-payments of up to 25% of a drug's purchase price have led to patients struggling to afford inhaled medications. Treatment nonadherence has been reported, resulting in 11.5% more exacerbations and 14.1% more hospitalisations annually, while the mean cost per severe COPD exacerbation has been approximated as €2600. Greece is a noteworthy example illustrating how COPD burden, quality of care and patients' outcome can be affected by economic crisis.

show abstract

Section: Secondary Prevention Of Copd In the Years Of Economic Crisismentioning

confidence: 99%

Section: Secondary Prevention Of Copd In the Years Of Economic Crisismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Impact of the financial crisis on COPD burden: Greece as a case study

et al. 2018

View full text Add to dashboard Cite

show abstract

“… 2 – 3 In Greece, the prevalence of COPD was found to range from 3.5% (in general population) to 8.4% (in those aged >35 years with smoking history) and 18.4% (in individuals >30 years old); 4 – 6 however, there are many studies supporting the idea that the disease remains largely underestimated and undiagnosed. 4 , 7 – 10 …”

Section: Introductionmentioning

confidence: 99%

The annual direct costs of stable COPD in Greece

Stafyla

Geitona

Kerenidi

et al. 2018

COPD

View full text Add to dashboard Cite

IntroductionChronic obstructive pulmonary disease (COPD) places a major burden on health care systems and has substantial economic effects; however, the cost of stable disease in Greece has never been thoroughly explored. The objective of the study was to estimate the annual COPD patient cost during the maintenance phase and explore the relationships between the cost and disease severity.MethodsData were collected from 245 COPD patients (male: 231, mean age: 69.5±8.8 years) who visited the outpatient unit of University Hospital of Larissa in 2014 and 2015. Patients were classified according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, and the patients’ direct cost during the maintenance phase was calculated.ResultsEleven percent of COPD patients were stage I, 48.2% were stage II, 29% were stage III, and 11.8% were stage IV. According to the GOLD groups, 23.3% of patients were grade A, 15.5% were grade B, 22.9% were grade C, and 38.4% were grade D. The mean annual direct cost for stable disease was estimated at €1,034.55 per patient, of which €222.94 corresponded to out-of-pocket payments. The annual cost ranged from €408.23 to €2,041.89 depending on GOLD stages (I–IV) and from €550.01 to €1,480.00 depending on GOLD groups (A–D). The key cost driver was pharmaceutical treatment, which reflected almost 71% of the total expenses for the management of stable disease. The mean annual per-patient cost was two to three times higher for those with advanced disease (stages III–IV) compared to those with stages I–II disease, and it doubled for “high-risk” patients (groups C–D) compared to “low-risk” patients (groups A–B).ConclusionThe cost of COPD during the maintenance phase is remarkable, with the key cost driver found to be pharmaceutical treatment and social insurance funds the key payer for treating COPD patients in Greece. The cost of stable disease is proportional to the severity of COPD, and it is doubled in patients who belong to high-risk groups.

show abstract