ASSESSMENT OF STAGE APPROPRIATE MEDICAL CARE GIVEN TO COPD PATIENTS IN PERIPHERAL HEALTH CARE SYSTEMS

Abstract

BACKGROUND Among all major chronic diseases, COPD is the only disease that shows a rising mortality. Estimates show that COPD will become the third leading cause of death worldwide by 2030. While analysing the history and records of patients, it is evident that majority of COPD patients were getting treatment, which were different from the currently accepted guidelines. Aim of the Study-To determine the proportion of COPD patients getting treatment as per currently accepted guidelines from peripheral health care systems. MATERIALS AND METHODS Institution based cross-sectional study conducted in the Department of Pulmonary Medicine, Medical College, Trivandrum from March 2012 to November 2013. Study population constitutes patients who were referred from peripheral health centres with the diagnosis of COPD and confirmed as COPD in the study. They were evaluated with a structured questionnaire after taking consent. Patients with no medical records were excluded. RESULTS We assessed the stage appropriate management of COPD from peripheral health care systems under five categories, i.e. smoking cessation, pharmacotherapy, vaccination, pulmonary rehabilitation and home oxygen therapy. Out of the 144 subjects, stage appropriate pharmacotherapy is seen in 19.7% and 81.6% had received at least one of the non-recommended medications. And none of the patients had a Pulmonary function testing done. None of the medical officers working in the peripheral health care centres had followed the "5 As" of smoking cessation programme. Pulmonary rehabilitation was not prescribed to any of the COPD patients. Vaccination with Pneumococcal and Influenza vaccine was not given to any COPD patients. And finally none of the COPD is receiving home oxygen from peripheral health care centres. Also, we tried to assess the awareness about COPD among the patients and results are quite disappointing. CONCLUSION Even though GOLD guidelines of COPD have been accepted worldwide, the dissemination and application of these guidelines at peripheral level in India is not happening.