Continuous Quality Improvement Programme for COPD Patients - Two assessment cycles

Clinical Research Results Abstract Research Idea Abstract Service Development & Evaluation Abstract Aim: Maximize lung function assessment, establishing a target of one FEV1 in each three-years, and increase vaccination coverage (anti-flu and anti-pneumococcal) by 10% in patients with Chronic Obstructive Pulmonary Disease (COPD) in a health unit. Context: COPD has a prevalence of 11.7% worldwide and 14% in Portugal, representing one of the leading death causes. Regular monitoring and vaccination are essential to prevent exacerbations and reduce mortality. In our unit, more than half of the patients had neither updated lung function evaluation nor vaccination. Intervention: Continuous quality improvement with two evaluation cycles at three-years interval. During the first cycle (2018), we performed an educational session for health professionals, diagnoses revision and patients' invitation to update their spirometry by AirSmart-Spirometer® (adherence 35%). Patients were contacted for anti-flu and anti-pneumococcal vaccination (adherence 66% and 22%). In 2021, a new list of patients was drawn and spirometry and vaccination were evaluated. Lessons learned: We found a similar COPD prevalence in both cycles (1.1%vs1.2%). At the beginning of the first cycle, the proportion of patients with updated FEV1 was 45.6%, increasing to 64.6% after intervention. In the second cycle, we found updated spirometry in 58.5% of patients. The vaccination coverage rate improved after intervention and at follow-up, compared to baseline: anti-flu (0%vs66%vs69%) and anti-pneumococcal (31%vs45%vs47%). We found 96% adherence to COVID-19 vaccination. Message: The intervention had sustained effects as the proportion of users with updated spirometry in 2021 was higher than baseline. Although lower than the post-intervention values, we consider that awareness was maintained. This difference is justified by the difficult access to spirometry in the pandemic. The prevalence found is lower than in the literature, alerting us to underdiagnosis. Greater gains were seen in vaccination coverage. We conclude that this methodology applied on a large scale would maximize the control of COPD patients. Declaration of Interest The authors declare there are no conflicts of interest. References and Clinical Trial Registry Information Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease, Global Initiative for Chronic Obstructive Lung Disease (GOLD). 2022.Diagnóstico e Tratamento da Doença Pulmonar Obstrutiva Crónica no Adulto. Norma 005/2019. Direção Geral da Saúde. 2019.Vacinação contra a gripe. Época 2021/2022. Norma 006/2021. Direção Geral da Saúde. 2021.Vacinação contra infeções por Streptococcus pneumoniae de grupos com risco acrescido para doença invasiva pneumocócica (DIP). Norma 011/2015. Direção Geral da Saúde. 2015.Campanha de Vacinação Contra a COVID-19. Norma 002/2021. Direção Geral da Saúde. 2021.