my conflicts of interest during the last two years
DESCRIPTION
My conflicts of interest during the last two years. GSK has supported my participation in ERS congress 2010. Best Practice Finland: COPD Action Programme – 10 year results. Anne Pietinalho, Ass. Prof., Dr, FCCP Chief physician, Raasepori Health Care center - PowerPoint PPT PresentationTRANSCRIPT
My conflicts of interest during the last two years
• GSK has supported my participation in ERS congress 2010
Utrecht, September the 23th 2011
Best Practice Finland: COPD Action Programme –
10 year resultsAnne Pietinalho, Ass. Prof., Dr, FCCP
Chief physician, Raasepori Health Care center
and a specialist in Filha (Finnish Lung Health Association)
Utrecht, September the 23th 2011
Backgrounds and goals
Utrecht, September the 23th 2011
Key points and figures at the start of the program
• Population: 5.2 million inhabitants
• Smokers: > 1 million
• COPD: 200 000 patients
• Tobacco Legislation :
• 1977 - Ban on advertising
• 1995 - Ban on smoking in public places and at work
• 4 important authorities on the respiratory field gave a proposal to the Ministry of Social Afairs and Health in 1996
COPD Program 1998–2007
Utrecht, September the 23th 2011
Goals of prevention and treatment
1.1. To decrease the incidence of chronic bronchitis. To decrease the incidence of chronic bronchitis.
2.2. To achieve recovery of as many chronic bronchitis patients as possible. To achieve recovery of as many chronic bronchitis patients as possible. 3.3. COPD patients feel well, and their capacity for work and function remains COPD patients feel well, and their capacity for work and function remains good.good.
4.4. To decrease the proportion of severe and moderate COPD. To decrease the proportion of severe and moderate COPD.
5.5. To decrease the number of bed-days of COPD patients by 25%. To decrease the number of bed-days of COPD patients by 25%.
6.6. To decrease the annual costs per patient. To decrease the annual costs per patient.
Utrecht, September the 23th 2011
Implementation – to whom, how, what and how much?
• Information for• all health care workers &• population
• Multidiciplinary education/trainingin • good collaboration together with Filha, specialized health care,
occupational health care and primary health care but also private doctors and nurses were invited
• training events• publications• internet based information
• Training consisted of presentations concerning• COPD as a disease, diagnosis (spirometry), treatment , smoking
cessation and rehabilitation• Totally
• 900 events• for 25 000 health care workers
Utrecht, September the 23th 2011
What else was ongoing during the time of the program?
• Asthma Program 1994-2004
• EB guide lines • 1999 for COPD• 2000 for asthma• 2002 for smoking cessation• 2006 for Non Invasive Ventilation
• Changes in the health care organization• fewer hospital places• more outpatient based treatment
• Stronger tobacco legislation• 2003 - tobacco smoke carcinogenic• 2007 - ban on smoking in restaurants
Utrecht, September the 23th 2011
Results
(Kinnula V et al Prim Care Resp J 2011;20(2):178-183)
Utrecht, September the 23th 2011
Knowledges, skills and resources
• Health care personnel has • improved knowledges and skills on COPD• improved attitudes towards smokers and COPD patients
• Population has now better knowledge on COPD
• Primary health care has improved • resources: 700 asthma nurses in primary health care take also
care of COPD and smoking cessation• tools: PEF-meters and spirometry equipments in all healt care
stations
• Pharmacies have• 700 asthma contact persons taking care of COPD and smoking
cessation as well
Utrecht, September the 23th 2011
COPD prevalence among the adults has not risen
• 1978-1980: males 4.7%, females 2.2%• 2000-2001: males 4.3 %, females 3.1%
Utrecht, September the 23th 2011
Vasankari TM et al. ERJ 2010
Quality of spirometry in the health care – use of recommended reference values
and calibration of the equipments
Utrecht, September the 23th 2011
Hospital days due to COPD in 1997–2007
0
5000
10000
15000
20000
25000
30000
Hospital days per 100 000 Men 65 years or over
Hospital days per 100 000 Women 35-64 years
Hospital days per 100 000 Women 65 years or over
Utrecht, September the 23th 2011
Number/100 000
Hospital days per 100 000 Men 35-64 years
National Institute for Health and Welfare
Smoking among adults in Finland
Utrecht, September the 23th 2011
p<0.001
Y 2010M 23%F 16%National Institute for Health and Welfare
Retirements due to COPD
0
100
200
300
400
500
600
700
800
Retirements due to COPD
Retarements due to all respiratory diseases
Number of patients who have got rehabilitation due to COPD
Social Insurance Institution
Utrecht, September the 23th 2011
Retirements due to all
Mortality due to COPD
Year All Men % of all
1997 1055 795 75
2007 1 094 806 74
Utrecht, September the 23th 2011
Statistic Finland
Costs due to COPD in Finland
milj eur
Medicines +Hosp.treat.+Out patient
Tynkkynen et al 2009Utrecht, September the 23th 2011
0100200300400500600700800900
Asthma1993
Asthma2003
COPD1997
COPD2006
DisabilityMedicinesHospital treatmentOut patient
88%
Costs due to COPD in Finland
milj eur
Medicines +Hosp.treat.+Out patient
Tynkkynen et al 2009Utrecht, September the 23th 2011
0100200300400500600700800900
Asthma1993
Asthma2003
COPD1997
COPD2006
DisabilityMedicinesHospital treatmentOut patient
88%
Conclusions
• The implementation was a hard work but anyhow:• COPD is now a relatively well known disease among the population• The attitudes, knowledge and skills for COPD, spirometry and
smoking cessation among health care personnel have improved and the resources have increased
• The Program in combination with many other efforts had several positive consequences:
• stopping increase of COPD prevalence• reduction of smoking• improving quality of diagnosis • reduction of hospitalisations and costs for COPD• stopping increase of COPD costs
Utrecht, September the 23th 2011
Thank you for your attention!
Utrecht, September the 23th 2011