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Standards for COPD Care Now

EFA Releases its Book on COPD in Europe Seeking Minimum Standards of Care

At the EFA-ECC World Chronic Obstructive Pulmonary Disease (COPD) Day Event in Brussels on November 28th, the EFA Book on Minimal Standards of Care for COPD Patients in Europe was released. The publication, which is EFA’s second book on COPD, highlights necessary steps for establishing minimum standards of care for COPD patients across Europe, which would outline best practices for improve the quality of life for patients while decreasing the economic burden of their disease on national healthcare systems. The book follows up where the first EFA book on COPD left off in 2009, providing a foundation for patient-centred approaches to care standards for European countries.

Despite increasing awareness of COPD amongst healthcare professionals, the disease remains relatively unknown to the general public. The most recent ERS White Book has released data in 2013 which confirms the gravity of the situation, providing an excellent basis for scientific evidence in the prevalence of COPD in Europe. It remains a chronic disease with an increasing prevalence and is on track to become the third leading cause of death among chronic diseases in the world.

The idea to have another EFA book on COPD focusing on the topic of minimum standards of care originated from the members of EFA COPD Working Group, whom compiled a list of specific gaps in COPD patient care in their national contexts. There was sufficient overlap in areas for improvement that it was formally integrated into becoming part of a COPD Project. As a result, in the spring and summer of 2013, 16 countries with EFA members and partners were surveyed with a questionnaire concerning the status quo of patient care for COPD on specific care topics affecting COPD patients ranging from spirometry testing to rehabilitation and smoking cessation services.

With help from its Medical Advisor, Professor Jorgen Vestbø, former chair of the scientific committee for the Global Initiative for Chronic Obstructive Lung Disease (GOLD), EFA pinpointed the most interesting results of the survey and compiled them into an easily understandable text for the general public. EFA pinpointed 8 key interrelated areas which together provide a basis for patient-centered and minimum standards of care:

  1. Ensure early diagnosis of COPD by using spirometry testing in primary care for current and ex-smokers older than 35 years old;
  2. All general practitioners should be adequately educated to administer spirometry testing and interpret the results so as to assure early and accurate diagnosis;
  3. Coordination should be increased between primary care, specialists and hospitals to increase efficiency of treatment and quality of life for patients;
  4. Smoking cessation services and pulmonary rehabilitation should be made available for all COPD patients in need, regardless of their employment status;
  5. Increase the number of centres for COPD care and rehabilitation and ensure there are systematic plans in place for how to avoid exacerbations, consistent follow-ups with patients and intensive up-to-date training on the self-management of the condition;
  6. Promote a multidisciplinary approach for the rehabilitation of COPD patients to involve all necessary medical professionals who can help improve their quality of life with comorbidity assessments so as to efficiently treat all COPD patients;
  7. The participation of COPD patients should be legally embedded in all government decisions or processes directly affecting COPD patient care;
  8. Alpha-1 Antitrypsin Deficiency (AATD) testing should be available for infants and pregnant women at risk and augmentation therapy (AT) should be available in all European countries with the possibility of reimbursement.

The book outlines current care standards in Europe, underscores best practices which could help to improve the existing gaps in care and uses EFA’s eight requests above as a starting point for requesting change. The target audience includes policymakers, healthcare professionals, researchers of COPD, COPD patients themselves, the general public as well as other stakeholders.

Although the book confirms guidelines for COPD care are in use in all countries surveyed, the late diagnosis of COPD patients and inconsistencies concerning which medical professionals will issue spirometry remain serious problems. Where general practitioners (GPs) would use spirometry, it is not necessarily the case they are adequately trained to interpret the results. Additional issues highlighted in the book include the access and reimbursement of smoking cessation and pulmonary rehabilitation; the inconsistent involvement of patients in decision making for COPD care; and inconsistent follow-ups and coordination amongst healthcare professionals responsible for care.

As many countries do not employ multidisciplinary approaches to COPD management, particularly considering other comorbidities, EFA has also called for increased attention to these two areas. If more collaboration between healthcare professionals of different specialties is possible in a patient’s care it could help to map out a personalized approach to their care which also considers pre-existing comorbidities or other conditions to which a patient could be at high risk to contract.

An electronic copy of the book is available for download on EFA’s website here and the order of physical copies can be discussed by calling +32(0)22272712 or contacting info@efanet.org. Inquiries concerning the book can be sent to EFA Fundraising and Programme Officer Antje Fink Wagner (antje.finkwagner@efanet.org) or EFA Membership and Programme Officer David Brennan (david.brennan@efanet.org).

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