COPD health care in Sweden - A study in primary and secondary care.
OBJECTIVE
To map out-patients with Chronic Obstructive Pulmonary Disease (COPD) with special reference to patients suffering from acute exacerbations, and to describe COPD health care structure and process in Swedish clinical practice in a real life setting.


METHODS
Retrospective, non-interventional, epidemiological survey.


METHODS
141 hospital based out patient clinics (OPC, n=30) and primary health care clinics (PC, n=111) were included in the structure evaluation.


METHODS
1004 COPD diagnosed patients from 100 of the centres (OPC, n=26) participated in the process evaluation.


METHODS
All Swedish OPC (n=40) and a random sample of 180 PC were asked to answer a questionnaire regarding COPD care. In addition, data from 10 randomly selected patients with a documented COPD disease were analysed from the centres.


RESULTS
Spirometers were available at all OPCs and at 99% of the PCs. Spirometry had been performed in 52% of PC-patients and in 89% of OPC-patients during the last 2 years prior to the study. More severe patients, as judged by investigator and lung function data, were treated at OPCs than at PCs. Physiotherapists, occupational therapists and dieticians were available at >80% of centres. Exacerbation rate was higher at PCs without a specialized nurse, 2.2/year versus 0.9/year at centres with a specialized nurse.


CONCLUSIONS
Special attention to COPD, marked by a specialised nurse in primary care improves the quality, as assessed by a lower number of exacerbations. The structure of COPD care in Sweden for diagnosed individuals seems satisfactory, but could be improved mainly through higher availability and educational activities.
Löfdahl
Claes-Göran
CG
Department of Respiratory Medicine and Allergology, Lund University Hospital, SE-222 41 Lund, Sweden. claes-goran.lofdahl@med.lu.se
Tilling
Björn
B
Ekström
Tommy
T
Jörgensen
Leif
L
Johansson
Gunnar
G
Larsson
Kjell
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019983:Guideline Adherence / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D017064:Process Assessment, Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics / Q000451:nursing / Q000628:therapy*; D019984:Quality Indicators, Health Care; D011788:Quality of Life; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D013147:Spirometry / Q000191:economics; D011795:Surveys and Questionnaires; D013548:Sweden; D016896:Treatment Outcome