Management of COPD, equal treatment across age, gender, and social situation? A register study

Abstract

Chronic obstructive pulmonary disease (COPD) is a progressive chronic disease where treatment decisions should be based on disease severity and also should be equally distributed across age, gender, and social situation. The aim of this study was to determine to what extent patients with COPD are offered evidence-based interventions and how the interventions are distributed across demographic and clinical factors in the sample. Baseline registrations of demographic, disease-related, and management-related variables of 7,810 patients in the Swedish National Airway Register are presented. One-third of the patients were current smokers. Patient-reported dyspnea and health-related quality of life were more deteriorated in elderly patients and patients living alone. Only 34% of currently smoking patients participated in the smoking cessation programs, and 22% of all patients were enrolled in any patient education program, with women taking part in them more than men. Less than 20% of the patients had any contact with physiotherapists or dieticians, with women having more contact than men. Men had more comorbidities than women, except for depression and osteoporosis. Women were more often given pharmacological treatments. With increasing severity of dyspnea, participation in patient education programs was more common. Dietician contact was more common in those with lower body mass index and more severe COPD stage. Both dietician contact and physiotherapist contact increased with deteriorated health-related quality of life, dyspnea, and increased exacerbation frequency. The present study showed that COPD management is mostly equally distributed across demographic characteristics. Only a minority of the patients in the present study had interdisciplinary team contacts. Thus, this data shows that the practical implementation of structured guidelines for treatment of COPD varies, to some extent, with regard to age and gender. Also, disease characteristics influence guideline implementation for each individual patient. Quality registers have the strength to follow-up on compliance with guidelines and show whether an intervention needs to be adapted prior to implementation in health care practice.

Reducing socioeconomic inequalities in COPD care in the hospital outpatient setting - A nationwide initiative

“…Our findings of ethnic differences are in keeping with a US study showing that Afro-American patients were less likely to receive recommended care during a hospitalization for acute COPD exacerbation than Caucasian and Hispanic patients, and that this could be explained by Afro-American patients generally attending poor performance hospitals [9]. In contrast, our findings of a lower chance of receiving optimal care among patients living alone, a recent Swedish study indicated that patients living with someone were less likely to have contact with a physiotherapist and dietician and participate in smoking cessation programs [8]. This opposing finding could be due to differences in study populations, the Swedish study being dominated by relatively younger and less severely ill study patients followed in primary care where patients cohabiting may to larger extend depend on their partners for non-pharmacologic lifestyle interventions.…”

“…To our knowledge, the association between SES and quality of outpatient care for COPD patients is largely unexamined. A recent study using the Swedish National Airway Register indicated that patients living with someone were less likely to have contact with a physiotherapist and dietician and participate in smoking cessation programs [8]. However, the study population predominantly included patients from primary care in the earlier stages of disease.…”

Gender difference on the knowledge, attitude, and practice of COPD diagnosis and treatment: a national, multicenter, cross-sectional survey in China

“…The results were equal to another survey conducted in Sweden, which showed that drug treatment depended on disease severity. 36 More than 70% of the patients were satisfied with COPD drugs. Approximately 80% of the patients did not know the side effects of anticholinergic drugs, β-adrenergic agonists, ICSs, ICS/long-acting β2-agonist, and theophylline.…”

The Swedish National Airway Register (SNAR): development, design and utility to date

“…At that time, the variables in SNAR were modified to harmonize with these recommendations, which presents a unique opportunity to use data from SNAR to evaluate the effect of this national effort. Several papers presenting COPD data from SNAR have been published [19][20][21][22]; however, a comprehensive presentation of SNAR across the spectrum of obstructive lung disease has not yet been undertaken. Accordingly, this paper aims to describe the development and design of SNAR, and to study the 2019 data to evaluate its potential utility related to improvement of quality of care.…”