Original Title: Portrait de la maladie pulmonaire obstructive chronique au Québec de 2016 à 2022 : Résultats d’indicateurs sur le parcours de soins

Authors' objectives: In addition to pharmacological and non-pharmacological treatments that to some extent reduce symptoms, prevent complications, and improve quality of life, self-management educational and motivational interventions integrated into regular disease management are essential, as is effective care and service coordination. As part of the INESSS’s mission to support the optimization of healthcare pathways, the present work aimed to describe the prevalence of COPD across the province, the sociodemographic characteristics of people with the disease, and certain domains of healthcare quality for the period between 2016 and 2022. The mandate also included a literature review of COPD quality indicators that use primary care electronic medical records (EMRs) to potentially support a wider range of strategies for continuous improvement of care and services to people with COPD.

Authors' results and conclusions: HIGHLIGHTS OF INDICATOR RESULTS (#1 The number of COPD cases increases by around 10,000 each year in Quebec): This is due, in particular, to the aging of the population and the increased life expectancy with the disease. Approximately 10% of the population aged 35 and over has been diagnosed with COPD, representing nearly 520,000 people in 2021-2022. (#2 Access to primary care is not optimal for many people diagnosed with COPD): In 2021-2022, around 15% of people with a COPD diagnosis were not registered with a family doctor. On the other hand, if we consider only COPD patients registered with a family doctor practising in an FMG, we note that the proportion of front-line visits made to the registered FMG (location continuity) is high (around 94% since 2016). This good result for location continuity does not, however, guarantee good accessibility to front-line services, which would reduce the use of other types of services. (#3 Nearly one in five people with a COPD diagnosis were hospitalized at least once during the year): In 2021-2022, 12% of people with a COPD diagnosis were hospitalized once, and 6% twice or more. This represents a significant number of hospitalizations, although it is not possible to evaluate the proportion of these hospitalizations that were preventable. In addition, less than half (43%) of cases had an ambulatory follow-up with a family doctor, primary care nurse practitioner (PCNP) or respirologist within 21 days of hospital discharge. (#4 Gaps have been identified in pharmacological treatment of people diagnosed with COPD): Only just over a third of COPD cases (38%) used a long-acting bronchodilator (LABA or LAMA) in 2021-2022, and this percentage has been stable in recent years. As it is recommended that all symptomatic people with spirometry-confirmed COPD should receive long-acting bronchodilator maintenance therapy, the results for this indicator seem relatively low. (#5 Relatively large variations have been observed between regions for all these indicators): In most cases, regional comparisons adjusted for age and gender show differences between urban or metropolitan areas and more rural or remote regions. These differences can be partly explained by variations in the way care is organized and in access to services. USE OF LOCAL DATA: The literature has identified a number of indicators calculated on the basis of data collected in the EMRs. They cover the whole range of primary care COPD management: • smoking evaluation and interventions; • case identification and confirmation of diagnosis; • management and follow-up of acute exacerbations; • ongoing follow-up and integration of care and services; • choice and adjustment of pharmacological treatments. However, not all the identified indicators are currently usable in Quebec, according to the stakeholders consulted, as the data elements required for their calculation are not systematically documented in the EMRs. A list of these elements has therefore been compiled to support the eventual implementation of such indicators as part of continuous improvement activities, but also for the benefit of COPD patients. CONCLUSION: COPD prevalence stabilized in Quebec between 2016 and 2022, but the burden on the healthcare system continues to grow as the number of cases gradually increases, due in particular to the aging of the population. Despite the limitations associated with indicators based on clinical-administrative data, the results highlight certain issues concerning access to primary care and inadequate or suboptimal maintenance treatment for COPD patients in Quebec.

Authors' methods: This state of practice is based on three sources of information: 1) Clinical-administrative data analysis associated with certain aspects of COPD management from fiscal years 2016-2017 to 2021-2022. The indicators presented come from a pilot project for the continuous improvement of the quality of care and services to people with COPD. As part of this project, participating family medicine groups (FMG) receive a report with data specific to their registered clientele. This overview describes the same results, but for the province as a whole. VI 2) Literature review The aim of the literature review was, on the one hand, to identify indicator results from other jurisdictions for comparison with those obtained for Quebec and, on the other, to identify COPD-related indicators calculated from data recorded in the EMRs. Documents were selected according to predefined criteria based on these two research questions. 3) Advisory committee perspective This committee was made up of clinicians, researchers, and managers whose mandate was to provide information and support in the interpretation of discrepancies between expected and observed indicator results. The relevance of the content and the overall scientific quality of the state of practice were assessed by external reviewers who were not involved in the work.

Project Status: Completed

URL for project: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/portrait-de-la-maladie-pulmonaire-obstructive-chronique-au-quebec-de-2016-a-2022-resultats-dindicateurs-sur-le-parcours-de-soins.html

Year Published: 2024

URL for published report: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/portrait-de-la-maladie-pulmonaire-obstructive-chronique-au-quebec-de-2016-a-2022-resultats-dindicateurs-sur-le-parcours-de-soins.html

English language abstract: An English language summary is available

Publication Type: Other

Country: Canada

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: L'Institut national d'excellence en sante et en services sociaux (INESSS)