By Ashwin, UK Correspondent, [RxPG] More than one in ten patients with Chronic Obstructive Pulmonary Disease (COPD) admitted to hospital is dead within 90 days of admission, and over 1 in 3 are readmitted to hospital during that time.
These startling figures are outlined in the first ever comprehensive national audit of this condition, undertaken by the Royal College of Physicians (RCP) and the British Thoracic Society (BTS) between 2003/4. 234 hospitals in the UK took part in the audit, which is aimed at finding out ways of improving quality of care this is the first time the audit covered the whole of the UK.
COPD is a chronic disabling condition in which the patients airways have become obstructed, making it difficult to breathe, and the lungs themselves may have become damaged. It is the fifth most common cause of death in England and Wales. COPD accounts for more than 10% of all acute admissions, which makes it a priority area for all hospitals concerned with effective management of acute medical admissions, and for Primary Care Trusts trying to improve care for long-term conditions.
Patients have a better chance of survival if the unit they are admitted to has a respiratory consultant. However, only 30% of patients are admitted under a respiratory specialist, and 33% of Trusts have fewer than the BTS recommended minimum of 2 on any one site. Over half of patients (52%) are not under the care of a respiratory specialist whilst in hospital. The results of the audit show that an increase in the number of respiratory physicians and nurse specialists is needed to improve the care of patients with COPD.
Length of stay is also reduced in units led by respiratory specialists - these units are more likely to have an Early Discharge Scheme, which also reduces length of stay. More hospitals should implement Early Discharge Schemes and pulmonary rehabilitation. Non-invasive ventilation was available in 89% of units but the audit showed that this wasnt always used for patients who needed it. Fewer than one in seven patients who die in hospital receive added ventilatory support.
To prevent the wide variations in practice between hospitals the NICE guidelines should be implemented nationally. The Healthcare Commission could play a vital role in the long-term success of these measures by monitoring standards of care and management of COPD patients as part of their standards assessment. National Service Frameworks in key clinical areas have proved effective in raising standards of care - a National Service Framework for Respiratory Medicine would be a powerful tool to drive up standards of care nationally.
Dr Mike Roberts, COPD Associate Director of the RCPs Clinical Effectiveness and Evaluation Unit, said:
Care received by COPD patients remains a lottery with many not benefiting from the potentially life-saving and life-enhancing care provided by a specialist Respiratory team.
Professor Andrew Peacock of the BTS said:
This research is really worrying and underlines the need for more lung specialists across the board. It also underlines why the Government must give the green light as soon as possible for a National Service Framework (NSF) for respiratory disease. COPD must be given a greater priority within the NHS at both a local and national level.
An NSF is vital if we are to achieve uniform standards of care for patients with all lung conditions. It will send a priority signal to local NHS Trusts that COPD management is a real priority helping converts services such as non invasive ventilation and pulmonary rehabilitation from nice to to must do.
Dame Helena Shovelton, Chief Executive of the British Lung Foundation said:
This audit highlights the huge problem of COPD in the UK. The British Lung Foundation has campaigned for many years for better care and treatment for patients with COPD, and petitioned Downing Street for pulmonary rehabilitation to be available to everyone.
There are more than 900,000 people diagnosed with COPD in the UK and a suspected further 1.5 million undiagnosed - and it is time that the Government made COPD a priority.
Royal College of Physicians
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