Sandra Søgaard Tøttenborg

Improving quality of care among COPD outpatients in Denmark 2008–2011

To examine whether the quality of care among Danish patients with chronic obstructive pulmonary disease (COPD) has improved since the initiation of a national multidisciplinary quality improvement program.

Danish Register of chronic obstructive pulmonary disease.

Aim of database The Danish Register of Chronic Obstructive Pulmonary Disease (DrCOPD) is a nationwide database aiming to describe the quality of treatment of all patients with chronic obstructive pulmonary disease (COPD) in Denmark. Study population DrCOPD comprises data on all patients with a diagnosis of COPD. In the hospital setting, both in- and outpatients are included. In the setting of the general practice (GP), DrCOPD aims to include all patients with a COPD diagnosis who attend an annual control visit for COPD. Main variables DrCOPD includes information on forced expiratory volume in 1 second, smoking status, body mass index, dyspnea, treatment modalities such as rehabilitation, smoking cessation, medical treatment, and the use of noninvasive ventilation during hospitalization due to exacerbations. The outcome variables include frequency of readmission and death 30 days after discharge from hospital. Descriptive data Since 2008, the registration in the Danish hospitals has gradually become more comprehensive. In 2014, ~90% of 16,106 eligible patients had complete data sets that showed an improvement in the processes describing quality of care, including increased offering of smoking cessation, rehabilitation, and correct treatment with inhaled medication. Data from GPs have been included since 2011, but are still incomplete and comprise only ~20% of all COPD patients seen. The collection of data from GP settings has recently been hampered due to legislative controversies. Conclusion In relatively few years, DrCOPD has become increasingly comprehensive and has documented an improvement in the management of COPD in Danish hospitals.

Socioeconomic inequality in the use of prescription medications for smoking cessation among patients with COPD: a nationwide study

Background Bupropion and varenicline can substantially improve the chances of smoking cessation in patients with COPD, but are unsubsidized and relatively costly. We examined overall use and socioeconomic patterns of use among patients with COPD. Patients and methods We identified 4,741 COPD patients reporting to be smokers at their first contact for COPD during 2008–2012 in the Danish register of COPD, which covers all pulmonary outpatient clinics in Denmark. Patients were followed for 6 months in the National Prescription Registry. Logistic regression analyses were used to calculate the ORs with corresponding 95% CI of redeeming a prescription for any of the smoking cessation medications in strata of baseline characteristics. Results During 6 months from first consultation, only 5% redeemed a prescription for bupropion or varenicline. Younger age, female sex, higher education, and higher income were associated with an increased likelihood, while non-Danish ethnicity, living alone, and very severe COPD were associated with a lower likelihood of redeeming bupropion or varenicline. Conclusion Despite their proven effectiveness, bupropion and varenicline are sparingly used among COPD patients followed in the hospital outpatient setting with the lowest use among the socioeconomically disadvantaged. This highlights a missed opportunity for intervention.