COPD audit highlights inequalities in care
MedWire News: The quality of care for people with chronic obstructive pulmonary disease (COPD) varies significantly both within and between European countries, show results of the first-ever European audit of COPD care.
The audit, conducted in 2010 and 2011 on behalf of the European Respiratory Society (ERS), included data on care processes and 90-day clinical outcomes for over 16,000 patients from 422 centers across 13 European countries.
COPD is a highly prevalent disease affecting about 44 million people in Europe, explains background information in the report. In contrast to other major causes of death, its prevalence has increased in the past three decades.
Furthermore, evidence is growing that COPD patient care varies widely across institutions and is often not consistent with published guidelines. The audit was therefore conducted to investigate the extent of these inconsistencies.
The findings demonstrated that nearly half of all patients admitted to hospital with COPD exacerbation either died (11%) or were readmitted (35%) within 90 days. Prehospital and inpatient care of these patients varied considerably across the sites audited.
For example, there was significant variation in the proportion of admissions by gender, with women representing 53% of patients in the UK but only 14% of patients in Spain. The mean age of patients also varied among the countries, ranging from 63 years in Romania to 75 years in Spain.
Nearly all patients (90%) in Romania and Turkey were cared for in specialist respiratory wards, compared with just 12% in Switzerland and 18% in Ireland.
The audit found that 21% of hospitals did not have intensive care unit beds available for COPD patients, while 51% did not have a high dependency unit that accepted these patients. Half of hospitals audited reported that they had a respiratory specialist on call every day, with a range of one to 21 specialists on the staff in a single hospital.
Pre-admission treatment also varies widely across Europe: antibiotics were received by 7% of Austrian patients and 27% of UK patients; systemic steroid treatment ranged from 1% in Romania to 33% in Belgium; and less than 1% of Irish patients received intravenous theophylline, compared with 86% of Croatians.
Similar variations were observed for inpatient treatment. The lowest rates of noninvasive ventilation were reported in Poland (4%) and the highest rates were in Switzerland (31%). For mechanical ventilation, the lowest rates were observed in the UK, Ireland, and Romania (<1%) with the highest rates in Belgium (5%).
Of note, invasive mechanical ventilation was not available to COPD patients in 24% of hospitals, only half of hospitals offered pulmonary rehabilitation for discharged patients, and just 60% had formal access to palliative care services for end-of-life COPD patients.
The COPD Audit Steering Board says that the "unacceptable differences" in care that they observed "provides a compelling argument for review and reform."
It concludes by calling for the establishment of a European task force to drive COPD care reform as a priority across Europe, with the aim of "reducing inequalities both between and within countries and so raise the standard of care delivered to patients."
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By Laura Cowen