Management of chronic obstructive pulmonary disease (COPD) in primary care: a questionnaire survey in western Sweden

Abstract

Aim: To assess the primary care management of chronic obstructive pulmonary disease (COPD) in relation to COPD guidelines.Method: A postal questionnaire was sent out to all Primary Health Care Centres (PHCCs) in western Sweden (n=232). The response rate was 75%.Results: A majority of the PHCCs had a nurse and physician responsible for COPD care. They used spirometry equipment regularly, but only 50% reported that they calibrated it at least weekly. Less than 30% of the PHCCs reported access to a dietician, occupational therapist or physiotherapist. There was a structured smoking cessation program in 50% of the PHCCs. Larger PHCCs were more likely to use spirometry equipment regularly and to have specific personnel for COPD care. Conclusion:There is a need to establish structured programs for COPD care including smoking cessation programs for COPD patients with special trained staff. Larger PHCCs have a better infrastructure for providing guideline-defined COPD care.

Improved prediction of COPD in at-risk patients using lung function pre-screening in primary care: a real-life study and cost-effectiveness analysis

“…For example, in Sweden about 90% of primary health care centres (PHCC) have access to spirometers, but their use is limited. 4,5 Although there is increased access to spirometers, it is reported that primary care physicians seldom use spirometry to detect COPD in smokers or individuals with respiratory symptoms. 6 Population-based studies from different countries show that COPD is significantly under-diagnosed.…”

The nurse′s challenge of caring for patients with chronic obstructive pulmonary disease in primary health care

“…Thorn et al. () demonstrates, in a study in Sweden 2008, that larger PHCCs had better opportunities to design the care of this group of patients based on guidelines and recommendations. Several participants in our study expressed how they wished physicians had better knowledge of the care of patients with COPD and felt a lack of support, especially for patients with the most severe form of COPD.…”

“…Most considered it especially important to collaborate with physicians and physiotherapists, but several witnessed a lack of cooperation, particularly the nurses working alone as an ACN at the unit and missed discussing problems with colleagues. Thorn et al (2008) demonstrates, in a study in Sweden 2008, that larger PHCCs had better opportunities to design the care of this group of patients based on guidelines and recommendations. Several participants in our study expressed how they wished physicians had better knowledge of the care of patients with COPD and felt a lack of support, especially for patients with the most severe form of COPD.…”

Chronic Obstructive Pulmonary Disease: Perspectives for Primary Health Care

“…Because of COPDs high incidence in Sweden, specialized centers exist to offer primary care that includes spirometry and trained nursing personnel. This approach has reduced the number of exacerbations from 2.2 to 0.9 visits/year 46 , despite the limited use of spirometry (available at only 50% of centers), and a moderate anti-smoking advice (50%), increased influenza vaccinations (60%), and substantially lowered the number of referrals to pulmonary rehabilitation (19%) 47 .…”