COPD in the Master Plan for Respiratory Diseases (PDMAR)

Barcelona, 16th June 2010Joan Escarrabill, MDInstitut d’Estudis de la Salut

Barcelona

Joan Escarrabill, MDInstitut d’Estudis de la Salut

Carme Hernández, RNHospital Clínic

Mª Antònia Llauger, MDCAP Maragall

Núria Roger, MDConsorci Hospitalari de Vic

Ricard Tresserras, MDDirecció General de

Planificació i Avaluació

Ms. Alba RosasDirecció General de

Planificació i Avaluació

Esteve Saltó, MDDirecció General de

Salut Pública

Josep Jiménez, MDCatSalut

Agenda

Challenges

4

Clinical decisions

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

Different strategies regarding respiratory diseases

www.lunghealthframework.ca/

Ensure proper treatment.

Recommend prevention strategies to local communities.

Give support to patients with COPD and their caregivers through education and practical advice to manage their disease.

Recommendations to apply locally

35 objectives35 objectives

59 recommendations59 recommendations

• Interest in the whole process• Difficulty to translate some objectives locally process over outcome

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

Med Clin (Barc). 2008;131(Supl 4):42-6

To improve the care for patients with respiratory diseases.

Territorial perspective.

“ The actions are defined based on the principles of equality of access, equity, effectiveness, efficiency, coordination and quality of services, community participation and user satisfaction “

Advisory Council

President

Steering Committee

Director

Proposes criteriaDefine actionsEvaluation Working groups

Projects

Med Clin (Barc). 2008;131(Supl 4):42-6

Advisory Council

Josep Ma Antó, MD

Steering Committee

Joan Escarrabill, MD

Proposes criteriaDefine actionsEvaluation Working groups

Projects

Med Clin (Barc). 2008;131(Supl 4):42-6

Chronic diseases

Participation

TeamsNetworks

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)

Bias to avoid

Focus

Global Disease

Provision of servicesThe designer of the plan is not responsible for

the provision of health services

Responsibles for the provision of health services

Agenda

41%

COPD: Incidence

Tall transversal març/any

Discharges for respiratory cause. 2008

22

Health Region Discharges Respiratorydischarges

%

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

Source: CMBD. Servei Català de la Salut. 2008.

23

93% admission from ER15% readmissions 30 d.

Source: CMBD. Servei Català de la Salut. 2008.

Discharges for respiratory cause. 2008

29,8 26,4 24,1 19,927,3

17,3

16,824,7

143,6

121,6 124,6116,2

124,2 125,5120,4

122,5

0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 Total

MPOC Altes /10000 hab Total Altes/10000 hab

Total Discharges/ COPD Discharges (2007)

COPD Total

Spirometries hospital/year

ALT PIRINEU-ARAN

GI RONA

LLEIDA

CENTRAL

BARCELONA

TARRAGONA

TERRES DE L'EBRE

Garrigues

Alt Empordà

BaixEmpordà

Maresme

VallèsOriental

VallèsOccidental

BarcelonèsBaix

Llobregat

Cerdanya

Solsonès

Bages

Berguedà

Ripollès

Osona

Selva

Pla del’Estany

Garrotxa

Garraf

Segrià

Concade Barberà

Segarra

Noguera

Priorat

PallarsSobirà

PallarsJ ussà

Gironès

Alt Penedès

Anoia

TarragonèsBaix

Camp

Urgell

Alt Urgell

AltCamp

Baix Ebre

AltaRibagorça

BaixPenedès

Montsià

Riberad’Ebre

TerraAlta

Plad’Urgell

Val d’Aran

ESpirometries (in the hospital) / 100 inhab / year

Source: Survey “Spirometries in the Hospital” PDMAR 2009

1,36 spirometries / 100 inhabitants / year

108861,6/100

54731,04/100

10491,5/100

36771/100

21621,1/100

707401,45/100

60321,2/100

Spirometries hospital/yearBarcelona Health Region

Source: Survey “Spirometries in the Hospital” PDMAR 2009

Training of professionals who carry out spirometry

In more than half the cases there is no formal training

Fuente:. Encuesta Espirometrías Hospitales PDMAR 2009

Workshop on sleep disorders

28

March 17th, 2010

732,5

535,2561,4

756,5

578,9

724

0

100

200

300

400

500

600

700

800

Lleida Tarragona Ebre Girona Cat Central Area metropolitana

Taxa/100.000 hab

0,7% of the population

> 50.000 CPAP users

667,9 patients x 106 hab.

Drugs

ATC: R01AD+R03BA (R01AD:Corticosteroides; R03BA:Glucocortocoides)

Agenda

General objectives 2010

32

Opportunistic strategy

+

Planification

Activities around the spirometry

Palamós, 30/11 y 1/12 de 2009St Fruitós de Bages, 16-17/6 de 2009

Activities 2010

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Model of care for sleep disordersSmoking cessation in acute COPDSpirometry network for quality control

Model of care for sleep disordersSmoking cessation in acute COPDSpirometry network for quality control

Clinical leadership course (Vic 2010-11)

Clinical leadership course (Vic 2010-11)

Smoking cessation in acute COPD

Survey “Spirometry in Primary Care”

Survey “Spirometry in Primary Care”

Survey “COPD acute care”

Survey “COPD acute care”

Model of care for pulmonary hypertension

Model of care for pulmonary hypertension

...and the money?

35

The Master Plan has no specific budget...

... but makes proposals

PDMAR... Summary

36