Abstract ers 2005
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The document discusses the impact of Denmark's national oxygen register on adherence to guidelines for long-term oxygen therapy (LTOT) in COPD patients. Some key findings from 1994-2000 include an increase in the prevalence and incidence of COPD patients on LTOT, more patients receiving mobile oxygen and starting LTOT after hospitalization. Documentation of hypoxemia improved but only about half of patients received follow-up and 20-25% still smoked. Survival rates increased over time but remained lower than other countries. The register data was not optimally utilized and direct feedback to doctors may help further improve LTOT guideline adherence.
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Abstract ers 2005
- 1. The impact of a national oxygen register on the adherence to guidelines for LTOT in COPD patients Thomas Ringbæk, Hvidovre Hospital Peter Lange, Hvidovre Hospital
- 2. Background: Several studies have shown poor quality of LTOT in COPD pts. Aims of this study: Has a national oxygen register any impact on adherence to guidelines for LTOT: -administration >15 hrs daily -follow up 1-6 months after start -no smoking -hypoxaemia documented Changes in prevalence, incidence, patients´ characteristics, oxygen devices, and survival
- 3. Methods Data from The Danish Oxygen Register in the period 1994 to 2000
- 4. The Danish Oxygen Register established Nov. 1994 The Danish Oxygen Register Oxygen suppliers Patients´ questionnaire Central Board of statistics Patients´ files 1. year Use of O2 Subjective effect Smoking status Flow Hrs/day Oxygen devices Responsible for LTOT Possible stop 1. year Diagnosis Lung function Blood gases Smoking status Diagnosis Hospitalisation Vital status
- 5. Covers 99% of all Danes (5.3 mill.) 17.658 on LTOT 8.487 with COPD
- 6. Dissemination of data from The Danish Oxygen Register Meetings Papers Feedback to doctors on request
- 7. Prevalence of COPD pts on LTOT 1994-2000 0 5 10 15 20 25 30 35 40 45 31.10.94 31.12.95 31.12.96 31.12.97 31.12.98 31.12.99 31.12.00 per100.000
- 8. Incidence of COPD pts on LTOT 1995-2000 0 5 10 15 20 25 30 1995 1996 1997 1998 1999 2000 per100.000
- 9. Changes in patients´ characteristics, prescription of LTOT, and delivered devices in the period 1995 to 2000 0 10 20 30 40 50 60 70 80 90 1995 1996 1997 1998 1999 2000 % Initiated after admission Outpatient clinic 1-6 months after start Started by GP 0 10 20 30 40 50 60 70 01.11.9431.12.9531.12.9631.12.9731.12.9831.12.9931.12.00 % Females Age>70 yrs Flow >1.5 L/minute 0 10 20 30 40 50 60 70 80 90 100 01.11.9431.12.9531.12.9631.12.9731.12.9831.12.9931.12.00 % Oxygen concentrator or liquid oxygen 15-24 hrs/day Mobile oxygen
- 10. Smoking status of COPD patients, residing in the central part of Copenhagen, and on LTOT in 1995 and 2000, respectively. 0 10 20 30 40 50 60 70 80 asked yes, smoking CO measured high CO asked or checked smokers 1995, n= 240 2000, n= 279 p>0.05
- 11. Hypoxaemia status*. Data from the central part of Copenhagen Nov. 1994 31.12.2000 N=145 N=214 83% 15% 2% 72% 16% 12% Hypoxaemic Normoxaemic Missing P=0.018*) PO2 <7.3 kPa or 7.3-8.0 kPa + clinical signs of chronic hypoxaemia All Danes: 57.5%
- 12. Survival rates of new COPD patients on LTOT from Denmark compared to patients from other countries 0 10 20 30 40 50 60 70 80 90 100 0 3 6 9 12 15 18 21 24 27 30 33 36 39 Months Cumulativesurvivalproportion(%)%) Denmark (n=5659) Sweden (n=403) Belgium (n=270) France (n=252) Australia (n=505) NOTT, COT (n=101) Japan (n=4552)
- 13. Survival of COPD patients who started LTOT in 1995 versus 1999 0,00 0,50 1,00 1,50 2,00 2,50 3,00 3,50 4,00 4,50 5,00 5,50 6,00 Years 0,0 0,2 0,4 0,6 0,8 1,0 CumSurvival Year of start 1995 1999 Median 1.07 vs 1.40 yrs; p=0.032
- 14. Conclusion (1) ↑ incidence and prevalence of COPD (to 27 and 42 per 100.000) ↑ mobile oxygen ↑ started after hospitalisation ↑ age ↑ ”15-24 hrs/day”
- 15. Conclusion (2) Only about 50% are followed up ↑ documented hypoxaemia At least 20-25% are still smoking ↓ survival compared to other countries ↑ survival over time Not optimal utilization of data. Direct access to own data or current feedback?
- 16. Thank you for your attention
Editor's Notes
- According to the title of our presentation, I will present data on adherence to guidelines for COPD patients on LTOT in the period 1994-2000. Secondly, I present data on diagnosis ect. in this study period.
- Inspired by the Swedish and French Oxygen Register, we established The Danish Oxygen Register Nov. 1994. The oxygen suppliers: All patients on LTOT. Flow, hours daily, systems, doctor prescr. The first year all patients where asked to answer a questionnaire about use of oxygen, smoking, and the subjective effect of oxygen. From the files we got information on diagnosis, lung function, blood gases etc. Central Board of Statistics: Vital status and hospitalisation
- The Register covers nearly all Danes on LTOT. In the study period, more than 17.000 patients had been registered, And about half of these had COPD.
- The data was diss. Through meetings – local as well as national Through papers – in Danish and international And feedback to doctors on request
- In 1994 the prevalence was about 27/100.000. I the following years, it increased by about 50% to 42/100.000
- New COPD patients on LTOT. A smaller increase was seen for the incidence.
- About 60% of the COPD patients were females with no change over time. Age and flow increased significantly. Sign. increases were seen in delivered oxygen concentrators/liquid oxygen, prescribed oxygen 15-24 hrs daily, and delivered mobile oxygen. These trends were also seen for new patients. For new patients, we observed that most started right after a hospitalisation when they were clinically unstable, and this number increased. Only about half of the patients who had LTOT after 6 months had been seen in the out-patient clinic. Unfortunately, without any improvement over time. Fewer patients had LTOT started by a GP.
- In a sub sample of COPD pts. on LTOT, residing in the central part of CPH and comprising about 15% of all COPD pts on LTOT in Denmark, smoking status was examined in 1995 and 2000. -about 75% of the pts were asked about smoking. -nearly 20% admitted that they smoked -a little more than 50% had carbon monooxide measured – either in the blood or in the expired air. -about 15% had too high level -when the questionnaire and CO-test were combined, nearly 80% were examined. -and 20-25% were considered current smokers. No changes over time were seen. In 1994, the same figures were seen for all COPD pts. on LTOT in Denmark.
- In the same sub sample of patients, hypoxaemic status was examined in 1994 and 2000. In 1994, 72% of the pts had hypoxaemia detected, and this figure increased significantly to 83% in 2000. However, this sub sample was not representative fo all patients in Denmark. In 1994, 57.5% of all pts. Had hypoxaemia detected. Compared with the rest of the country, most of the patients in CPH had LTOT prescribed by a chest physician.
- Our COPD patients had worse survival compared to other countries. Especially high 6-month mortality rate was seen in our patients. It is difficult to explain this. In our study, the number of patients who started LTOT right after a hospitalisation was very high, and these patients had higher mortality than patients who started LTOT in the out-patient clinic. In the NOTT study all pts. And, I believe, in the Swedish study most of the pts. had LTOT prescribed in a clinical stable condition.
- In the study period, the median survial time was increased by 4 months – about 30%.
- So far, the utilization of data from this oxygen register has not been optimal. Direct access to own data and current feedback on adherence to guidelines for COT may improve the quality. This has been practiced in patients with hernia surgery. Two and an half year after implementation of The Danish Hernia Database, the quality of operation improved significantly (109). From this database, feedback was provided to participants twice yearly, with the results for the specific participant compared with the entire database.