In Practice COPD In Norway Kristian Jong Høines GP Specialist Tananger Legesenter Norway

The Norwegian Healt care system - how GPs are organized List system - average 1450 patients/GP 65% of GPs are specialist GP (5 years of training + recertification every 5 years) GPs organized in practices from one to several GPs Support straff; "Health secertary" - some nurses

The Norwegian Healt care system - how GPs are organized Payment model: Capitation fee; 46 € pr patient/year Patient payment; 15/20 € pr consultation (max 220 € pr year) Fee for service, example spirometry 21 € (reimbursed)

Epidemiology Calculated pervalence of 350.000 Diagnosed 100.000 11% of the population >40 years 13 % of the grown up population is currently daily smokers. (Youth, 16-24 currently 4%)

About the practice Four GPs and one intern Currently employed 4 nurses and 3 secretaries who covers 4,4 FTEs GP responsibility for about 5000 patients

Diagnosis There is currently no Screening for COPD in Norway COPD Diagnosis has to be done on suspicion and symptoms National guidlines urge GPs to actively look for COPD patients, as symptoms and sings might present late in the disease.

Diagnosis Is usually carried out in GP Almost all practices has spirometry Spirometry is most often carried out by nurses/secretaries The diagnostic criteria is mostly well known

Diagnosis At least half of the patients still without diagnosis Lack of capacity in lung specialists Still a need for improvement in general knowledge of the disease

COPD Follow-up Regular COPD follow up is clearly associated with better patient outcome What are the reasons for the lack of regularity in this in Norway for the time beeing?

COPD follow-up How often? What to controll? How to manage in a busy practice?

COPD Follow up - How often? Dependent on grade of disease Always 8-12 weeks after any change in medication. At least yearly in mild to moderat COPD At least twice yearly in stable severe COPD Within four weeks after being discharged from hospital

COPD Follow up - what to do Symptoms - use QLQ

COPD Follow up - what to do Symptoms - use QLQ Count exacerbations Control medications and inhalation technique Spirometry - at least yearly

COPD follow-up - How to do it? Patient information and education Make appointments - don´t wait for the patient to contact us Clinic organization - fill inn QLQ before visit Use nurses and secretaries actively in follow up

Annual COPD follow-up 1. Confirm diagnosis (spirometry, reversibility) 2. Register smoking status 3. Grade COPD 4. Remind influenza vaccine 5. Medication 6. Inhalation technique 7. Physiotherapy/Execercise/Rehabilitation

Areas of concern in Norway Challengens in the financial situation. Little reimbursement for annual COPD follow-up Lack of quality measurments in chronic diseases Currently too little goverment interest in multidisiplinary approach in GP Need for better IT support systems in follow up on COPD patients Lack of resources in rehabilitation

The END