Patterns of care in the management of high-risk COPD in Australia (2015-2019): an observational study for the CONQUEST quality improvement program.

Abstract

We compared the management of patients with 'high-risk' COPD in Australia to national/international guidelines and quality standards, including the COllaboratioN on QUality improvement initiative for achieving Excellence in STandards of COPD care (CONQUEST). Eligible patients in the Optimum Patient Care Research Database Australia were categorized as newly diagnosed (≤12 months after diagnosis), already diagnosed, or patients with potential undiagnosed COPD, in each year from 2015 to 2019. 'High-risk' patients had ≥2 COPD exacerbations/exacerbation-like events in the last 24 months. Descriptive statistics for 2019 are reported, along with annual trends. In 2019, 11.3% (2608/22,985) of eligible patients met high-risk criteria. Most newly diagnosed high-risk COPD patients (71.3%) had no recorded lung function testing within 12 months of diagnosis. 63.6% of new COPD diagnoses had no evidence of supporting spirometry or chest CT, with the remainder having recorded chest CT only. 44.3% of already diagnosed high-risk patients had no recorded inhaled maintenance therapy, although this was recorded for 11.2% of potential undiagnosed patients. Smoking cessation support and pulmonary rehabilitation were recorded for <40% and ≤2% of diagnosed COPD patients respectively. There is substantial opportunity to improve diagnosis, assessment and treatment of patients with COPD in Australia by identifying, reviewing and managing high-risk patients in accordance with evidence-based guidelines and CONQUEST standards. This study was conducted by Optimum Patient Care Australia Pty Ltd (OPCA) and was partially funded by OPCA and AstraZeneca Pty Ltd. No funding was received by the Observational & Pragmatic Research Institute Pte Ltd (OPRI) for its contribution.