Management of COPD, equal treatment across age, gender, and social situation? A register study.
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.
Angered Hospital, Research and Development Department; The Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg.
Ingela
I
Henoch
Angered Hospital, Research and Development Department; The Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg.
Susann
S
Strang
Angered Hospital, Research and Development Department; University of Lund, Lund.
Claes-Göran
CG
Löfdahl
Angered Hospital, Research and Development Department; Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
Ann
A
Ekberg-Jansson
D000367:Age Factors; D000368:Aged; D001993:Bronchodilator Agents / Q000627:therapeutic use; D015897:Comorbidity; D019033:Delivery of Health Care, Integrated / Q000592:standards; D018450:Disease Progression; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000592:standards; D054625:Healthcare Disparities / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D044623:Nutrition Therapy; D010348:Patient Care Team; D010353:Patient Education as Topic; D026741:Physical Therapy Modalities; D017064:Process Assessment, Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D019984:Quality Indicators, Health Care; D011788:Quality of Life; D012042:Registries; D012138:Respiratory Therapy / Q000379:methods* / Q000592:standards; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects; D016540:Smoking Cessation; D000074606:Smoking Prevention; D012959:Socioeconomic Factors; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome
D001993:Bronchodilator Agents
COPD; lung; quality register; socioeconomic status; treatments