Consumption and quality of health services for COPD patients: What is the impact of gender, socio-economic status and geography?

As other studies have found there are strong effects of gender and age. Men are more at risk of contracting COPD than women and the risk increase with age. There is significant geographic clustering in the prevalence of COPD in Norway. High prevalence clusters are evident in Southern Norway, Eastern Norway and some smaller clusters in Northern Norway. Low prevalence clusters can be found in Western Norway. The prevalence of life-style diseases such as COPD will generally vary with the socio-economic conditions of a society. This is also the case in Norway, despite a relatively homogenous population in socio-economic terms. Education is an especially important factor with a lowering of risk associated with higher education. Unemployment is another socio-economic factor of importance with increased risk associated with higher unemployment levels. There is also increased risk associated with urban dwelling compared to more rural places of residence and there is a lowering of risk in municipalities with a high degree of farming and fishery industries. Analyses of climatic conditions also show significant relationships to COPD-risk. The results show that temperature, wind speed and humidity all influence the dispensing of lung medication to COPD patients, in particular temperature extremes. This implies that the burden of the disease is also affected by climatic conditions. Another finding in this project is that COPD-patients use more psychoactive drugs in the form of benzodiazepines than nearly any other patient group, accentuating the severe mental stress caused by this disease. The high level of benzodiazepine use does, however, give rise to concerns given that they may cause respiratory depression. Hospitalization rates are significantly associated with higher benzodiazepine consumption among COPD-patients.

This project outlines a study of patients suffering from Chronic Obstructive Pulmonary Disease (COPD). Being able to identify better treatment paths for COPD patients will improve their health and quality of life, thus reducing number of hospitalisations and helping more persons to re-enter working life. Focusing on the consumption and quality of the services offered for these patients, we aim to study the role of socio-economic status, gender and geography, thus complying with the specified goals of both the national strategy of the Research Programme for Health and Care Services and the national strategy for COPD. The project consists of 3 work packages. Work package A: The main goal of work package A is to achieve a comprehensive view of the clinical m anagement and medical treatment of COPD patients at primary health care centers, and the patient flow between primary and hospital health care services. This work package combines data from up to 8000 patients, identified in primary health care centres in Mid-Norway, on prescription of medical drugs, spirometry testing, visits to casualty/outpatient clinics, and hospitalization. Work package B: Through a linkage of Norwegian patient data (i.e. hospital data) with data from the individual-based nursing and care statistics (IPLOS), NAV data on GP consultations, and data from the Cause of Death Registry, work package B focuses on the co-ordination and integration of services for COPD patients across service levels, and how this affects mortality-risks. Work package C: An integral part of work package C is to build a Nordic network on research on COPD, in order to undertake comparative analyses of the health service use of these patients in the Nordic countries. Utilising traceable patient data from the patie nt registries in the Nordic countries, the research activities in work package C will focus on the following aspects: patient flows, length of stay, resource use, waiting time for treatment and re-hospitalisations.