Characterization of secondary care for COPD in Sweden
Introduction: Only a selected proportion of chronic obstructive pulmonary disease (COPD) patients are managed in secondary care. The aim of this study was to characterize disease severity, treatment and structure of secondary care for COPD in Sweden. Methods: Information was collected from 29 of 33...
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doaj-515446502b644088a52f478bd637d0a82020-12-07T18:06:37ZengTaylor & Francis GroupEuropean Clinical Respiratory Journal2001-85252017-01-014110.1080/20018525.2016.12700791270079Characterization of secondary care for COPD in SwedenJosefin Sundh0Christer Janson1Gunnar Johansson2Anders Lindén3Claes-Göran Löfdahl4Thomas Sandström5Kjell Larsson6Örebro UniversityUppsala UniversityUppsala UniversityKarolinska InstitutetLund UniversityUmeå UniversityKarolinska InstitutetIntroduction: Only a selected proportion of chronic obstructive pulmonary disease (COPD) patients are managed in secondary care. The aim of this study was to characterize disease severity, treatment and structure of secondary care for COPD in Sweden. Methods: Information was collected from 29 of 33 existing secondary care units of respiratory medicine in Sweden, using both individual data from 373 consecutively enrolled COPD patients with Global initiative on Obstructive Lung Disease (GOLD) stage III–IV and a structural questionnaire about available resources at the units. Patient data included exacerbations, health status assessed by COPD Assessment Test (CAT), lung function, comorbid conditions, pharmacological treatment and vaccinations. Structural data included available smoking cessation support, multidisciplinary rehabilitation, physical training, patient education and routine follow-up after exacerbations at the respective unit. All patients were reclassified according to the GOLD 2014 group A–D classification. Multiple linear regression investigated associations of available resources with number of exacerbations and CAT score. Results: According to GOLD 2014, 87% of the population were GOLD D and 13% were GOLD C. Triple inhaled therapy were prescribed in 88% of the patients. Over 75% of the units had resources for smoking cessation, multidisciplinary rehabilitation, physical training and patient education. Routine follow-up after exacerbations was available in 35% of the units. Being managed at units with access to structured patient education was associated with statistically significantly fewer exacerbations (adjusted regression coefficient (95% confidence interval) −0.79 (−1.39 to −0.19), p = 0.010). Conclusion: Most stage III–IV COPD patients managed at secondary care respiratory units in Sweden have maximized inhaled therapy and high risk disease even when reclassified according to GOLD 2014. Most units have access to smoking cessation, rehabilitation and patient education. Patients managed at units with structured patient education have a lower exacerbation risk.http://dx.doi.org/10.1080/20018525.2016.1270079gold classificationpharmacological therapystructural resourcespatient education |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Josefin Sundh Christer Janson Gunnar Johansson Anders Lindén Claes-Göran Löfdahl Thomas Sandström Kjell Larsson |
spellingShingle |
Josefin Sundh Christer Janson Gunnar Johansson Anders Lindén Claes-Göran Löfdahl Thomas Sandström Kjell Larsson Characterization of secondary care for COPD in Sweden European Clinical Respiratory Journal gold classification pharmacological therapy structural resources patient education |
author_facet |
Josefin Sundh Christer Janson Gunnar Johansson Anders Lindén Claes-Göran Löfdahl Thomas Sandström Kjell Larsson |
author_sort |
Josefin Sundh |
title |
Characterization of secondary care for COPD in Sweden |
title_short |
Characterization of secondary care for COPD in Sweden |
title_full |
Characterization of secondary care for COPD in Sweden |
title_fullStr |
Characterization of secondary care for COPD in Sweden |
title_full_unstemmed |
Characterization of secondary care for COPD in Sweden |
title_sort |
characterization of secondary care for copd in sweden |
publisher |
Taylor & Francis Group |
series |
European Clinical Respiratory Journal |
issn |
2001-8525 |
publishDate |
2017-01-01 |
description |
Introduction: Only a selected proportion of chronic obstructive pulmonary disease (COPD) patients are managed in secondary care. The aim of this study was to characterize disease severity, treatment and structure of secondary care for COPD in Sweden. Methods: Information was collected from 29 of 33 existing secondary care units of respiratory medicine in Sweden, using both individual data from 373 consecutively enrolled COPD patients with Global initiative on Obstructive Lung Disease (GOLD) stage III–IV and a structural questionnaire about available resources at the units. Patient data included exacerbations, health status assessed by COPD Assessment Test (CAT), lung function, comorbid conditions, pharmacological treatment and vaccinations. Structural data included available smoking cessation support, multidisciplinary rehabilitation, physical training, patient education and routine follow-up after exacerbations at the respective unit. All patients were reclassified according to the GOLD 2014 group A–D classification. Multiple linear regression investigated associations of available resources with number of exacerbations and CAT score. Results: According to GOLD 2014, 87% of the population were GOLD D and 13% were GOLD C. Triple inhaled therapy were prescribed in 88% of the patients. Over 75% of the units had resources for smoking cessation, multidisciplinary rehabilitation, physical training and patient education. Routine follow-up after exacerbations was available in 35% of the units. Being managed at units with access to structured patient education was associated with statistically significantly fewer exacerbations (adjusted regression coefficient (95% confidence interval) −0.79 (−1.39 to −0.19), p = 0.010). Conclusion: Most stage III–IV COPD patients managed at secondary care respiratory units in Sweden have maximized inhaled therapy and high risk disease even when reclassified according to GOLD 2014. Most units have access to smoking cessation, rehabilitation and patient education. Patients managed at units with structured patient education have a lower exacerbation risk. |
topic |
gold classification pharmacological therapy structural resources patient education |
url |
http://dx.doi.org/10.1080/20018525.2016.1270079 |
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