This document summarizes the Master Plan for Respiratory Diseases (PDMAR) in Barcelona from June 16, 2010. The PDMAR aims to improve care for patients with respiratory diseases with a focus on COPD. It outlines objectives such as reducing COPD incidence through primary prevention strategies. It also discusses recommendations, working groups, evaluation processes, and potential biases to avoid. Statistics on COPD hospital discharges and spirometry rates across health regions in Catalonia are presented. Planned activities for 2010 include developing models of care for sleep disorders and COPD, and surveys on spirometry and COPD acute care. The PDMAR does not have a specific budget but makes proposals.

1. COPD in the Master Plan for Respiratory Diseases (PDMAR) Barcelona, 16th June 2010 Joan Escarrabill, MD Institut d’Estudis de la Salut Barcelona

2. Joan Escarrabill, MD Institut d’Estudis de la Salut Carme Hernández, RN Hospital Clínic Mª Antònia Llauger, MD CAP Maragall Núria Roger, MD Consorci Hospitalari de Vic Ricard Tresserras, MD Direcció General de Planificació i Avaluació Ms. Alba Rosas Direcció General de Planificació i Avaluació Esteve Saltó, MD Direcció General de Salut Pública Josep Jiménez, MD CatSalut

3. Agenda

4. Challenges Clinical decisions

5. Health Research Policy and Systems 2009, 7(Suppl 1):I1

6. Different strategies regarding respiratory diseases

7. www.lunghealthframework.ca/

9. Recommendations to apply locally

11. Objetivo general 1 Reducir la incidencia de la EPOC Objetivos Específicos de prevención primaria:

14. Advisory Council President Steering Committee Director Proposes criteria Define actions Evaluation Working groups Projects Med Clin (Barc). 2008;131(Supl 4):42-6

15. Advisory Council Josep Ma Antó, MD Steering Committee Joan Escarrabill, MD Proposes criteria Define actions Evaluation Working groups Projects Med Clin (Barc). 2008;131(Supl 4):42-6

16. Bias to avoid Chronic diseases Participation Teams Networks Metropolitan perspective Weight of the vision macro and academic Specialist’s vision without the Primary Care perspective Medical vision without sharing with nursing and physiotherapy Importance of acute problems Social class Focus on adults Gender (patients and health professionals)

18. Focus Global Disease

19. Provision of services The designer of the plan is not responsible for the provision of health services Responsibles for the provision of health services

20. Agenda

21. 41% COPD: Incidence Tall transversal març/any

22. Discharges for respiratory cause. 2008 Source: CMBD. Servei Català de la Salut. 2008. Health Region Discharges Respiratory discharges % Alt Pirineu i Aran, 7.615 871 11,4 Barcelona, 688.472 58.368 8,5 Garraf i Alt Penedès, 19.122 2.589 13,5 Metropolitana Sud, 109.790 12.303 11,2 Barcelonès Nord - Maresme 70.986 8.827 12,4 Vallès 135.305 15.056 11,1 Barcelona ciutat 353.269 19.593 5,5 Catalunya Central 54.720 5.449 10,0 Girona 86.586 8.451 9,8 Lleida 43.476 3.549 8,2 Camp de Tarragona 67.004 6.202 9,3 Terres del Ebre 19.368 1.926 9,9 TOTAL 967.241 84.816 8,8

23. Discharges for respiratory cause. 2008 93% admission from ER 15% readmissions 30 d. Source: CMBD. Servei Català de la Salut. 2008.

24. Total Discharges/ COPD Discharges (2007) COPD Total

25. Spirometries hospital/year ESpirometries (in the hospital) / 100 inhab / year Source: Survey “Spirometries in the Hospital” PDMAR 2009 10886 1,6/100 5473 1,04/100 1049 1,5/100 3677 1/100 2162 1,1/100 70740 1,45/100 6032 1,2/100 1,36 spirometries / 100 inhabitants / year

26. Spirometries hospital/year Barcelona Health Region Source: Survey “Spirometries in the Hospital” PDMAR 2009

27. Training of professionals who carry out spirometry In more than half the cases there is no formal training Fuente:. Encuesta Espirometrías Hospitales PDMAR 2009

28. Workshop on sleep disorders March 17th, 2010 > 50.000 CPAP users 667,9 patients x 10 6 hab. 0,7% of the population

29. Drugs ATC: R01AD+R03BA (R01AD:Corticosteroides; R03BA:Glucocortocoides)

30. Agenda

31. General objectives 2010

32. Opportunistic strategy + Planification

33. Activities around the spirometry Palamós, 30/11 y 1/12 de 2009 St Fruitós de Bages, 16-17/6 de 2009

34. Activities 2010 Model of care for sleep disorders Smoking cessation in acute COPD Spirometry network for quality control Clinical leadership course (Vic 2010-11) Smoking cessation in acute COPD Survey “Spirometry in Primary Care” Survey “COPD acute care” Model of care for pulmonary hypertension

35. ...and the money? The Master Plan has no specific budget... ... but makes proposals

36. PDMAR... Summary