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Master Plan for Respiratory Diseases
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COPD in the Master Plan for Respiratory Diseases (PDMAR)
Barcelona, 16th June 2010Joan Escarrabill, MDInstitut d’Estudis de la Salut
Barcelona
Joan Escarrabill, MDInstitut d’Estudis de la Salut
Carme Hernández, RNHospital Clínic
Mª Antònia Llauger, MDCAP Maragall
Núria Roger, MDConsorci Hospitalari de Vic
Ricard Tresserras, MDDirecció General de
Planificació i Avaluació
Ms. Alba RosasDirecció General de
Planificació i Avaluació
Esteve Saltó, MDDirecció General de
Salut Pública
Josep Jiménez, MDCatSalut
Agenda
Challenges
4
Clinical decisions
Health Research Policy and Systems 2009, 7(Suppl 1):I1
Different strategies regarding respiratory diseases
www.lunghealthframework.ca/
Ensure proper treatment.
Recommend prevention strategies to local communities.
Give support to patients with COPD and their caregivers through education and practical advice to manage their disease.
Recommendations to apply locally
35 objectives35 objectives
59 recommendations59 recommendations
• Interest in the whole process• Difficulty to translate some objectives locally process over outcome
Objetivo general 1 Reducir la incidencia de la EPOC Objetivos Específicos de prevención primaria:
Med Clin (Barc). 2008;131(Supl 4):42-6
To improve the care for patients with respiratory diseases.
Territorial perspective.
“ The actions are defined based on the principles of equality of access, equity, effectiveness, efficiency, coordination and quality of services, community participation and user satisfaction “
Advisory Council
President
Steering Committee
Director
Proposes criteriaDefine actionsEvaluation Working groups
Projects
Med Clin (Barc). 2008;131(Supl 4):42-6
Advisory Council
Josep Ma Antó, MD
Steering Committee
Joan Escarrabill, MD
Proposes criteriaDefine actionsEvaluation Working groups
Projects
Med Clin (Barc). 2008;131(Supl 4):42-6
Chronic diseases
Participation
TeamsNetworks
Metropolitan perspective
Weight of the vision macro and academic
Specialist’s vision without the Primary Care
perspective
Medical vision without sharing with nursing and
physiotherapy
Importance of acute problems
Social class
Focus on adults
Gender (patients and health professionals)
Bias to avoid
Focus
Global Disease
Provision of servicesThe designer of the plan is not responsible for
the provision of health services
Responsibles for the provision of health services
Agenda
41%
COPD: Incidence
Tall transversal març/any
Discharges for respiratory cause. 2008
22
Health Region Discharges Respiratorydischarges
%
Alt Pirineu i Aran, 7.615 871 11,4
Barcelona, 688.472 58.368 8,5 Garraf i Alt Penedès, 19.122 2.589 13,5
Metropolitana Sud, 109.790 12.303 11,2
Barcelonès Nord - Maresme 70.986 8.827 12,4
Vallès 135.305 15.056 11,1
Barcelona ciutat 353.269 19.593 5,5
Catalunya Central 54.720 5.449 10,0
Girona 86.586 8.451 9,8
Lleida 43.476 3.549 8,2
Camp de Tarragona 67.004 6.202 9,3
Terres del Ebre 19.368 1.926 9,9
TOTAL 967.241 84.816 8,8
Source: CMBD. Servei Català de la Salut. 2008.
23
93% admission from ER15% readmissions 30 d.
Source: CMBD. Servei Català de la Salut. 2008.
Discharges for respiratory cause. 2008
29,8 26,4 24,1 19,927,3
17,3
16,824,7
143,6
121,6 124,6116,2
124,2 125,5120,4
122,5
0
20
40
60
80
100
120
140
160
1 2 3 4 5 6 7 Total
MPOC Altes /10000 hab Total Altes/10000 hab
Total Discharges/ COPD Discharges (2007)
COPD Total
Spirometries hospital/year
ALT PIRINEU-ARAN
GI RONA
LLEIDA
CENTRAL
BARCELONA
TARRAGONA
TERRES DE L'EBRE
Garrigues
Alt Empordà
BaixEmpordà
Maresme
VallèsOriental
VallèsOccidental
BarcelonèsBaix
Llobregat
Cerdanya
Solsonès
Bages
Berguedà
Ripollès
Osona
Selva
Pla del’Estany
Garrotxa
Garraf
Segrià
Concade Barberà
Segarra
Noguera
Priorat
PallarsSobirà
PallarsJ ussà
Gironès
Alt Penedès
Anoia
TarragonèsBaix
Camp
Urgell
Alt Urgell
AltCamp
Baix Ebre
AltaRibagorça
BaixPenedès
Montsià
Riberad’Ebre
TerraAlta
Plad’Urgell
Val d’Aran
ESpirometries (in the hospital) / 100 inhab / year
Source: Survey “Spirometries in the Hospital” PDMAR 2009
1,36 spirometries / 100 inhabitants / year
108861,6/100
54731,04/100
10491,5/100
36771/100
21621,1/100
707401,45/100
60321,2/100
Spirometries hospital/yearBarcelona Health Region
Source: Survey “Spirometries in the Hospital” PDMAR 2009
Training of professionals who carry out spirometry
In more than half the cases there is no formal training
Fuente:. Encuesta Espirometrías Hospitales PDMAR 2009
Workshop on sleep disorders
28
March 17th, 2010
732,5
535,2561,4
756,5
578,9
724
0
100
200
300
400
500
600
700
800
Lleida Tarragona Ebre Girona Cat Central Area metropolitana
Taxa/100.000 hab
0,7% of the population
> 50.000 CPAP users
667,9 patients x 106 hab.
Drugs
ATC: R01AD+R03BA (R01AD:Corticosteroides; R03BA:Glucocortocoides)
Agenda
General objectives 2010
32
Opportunistic strategy
+
Planification
Activities around the spirometry
Palamós, 30/11 y 1/12 de 2009St Fruitós de Bages, 16-17/6 de 2009
Activities 2010
34
Model of care for sleep disordersSmoking cessation in acute COPDSpirometry network for quality control
Model of care for sleep disordersSmoking cessation in acute COPDSpirometry network for quality control
Clinical leadership course (Vic 2010-11)
Clinical leadership course (Vic 2010-11)
Smoking cessation in acute COPD
Survey “Spirometry in Primary Care”
Survey “Spirometry in Primary Care”
Survey “COPD acute care”
Survey “COPD acute care”
Model of care for pulmonary hypertension
Model of care for pulmonary hypertension
...and the money?
35
The Master Plan has no specific budget...
... but makes proposals
PDMAR... Summary
36
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