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 results Anne 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: patients Tobacco Legislation : Ban on advertising 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. To decrease the incidence of chronic bronchitis. 2. To achieve recovery of as many chronic bronchitis patients as possible. 3. COPD patients feel well, and their capacity for work and function remains good. good. 4. To decrease the proportion of severe and moderate COPD. 5. To decrease the number of bed-days of COPD patients by 25%. 6. 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/training in 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 health care workers Utrecht, September the 23th 2011

What else was ongoing during the time of the program? Asthma Program 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 tobacco smoke carcinogenic ban on smoking in restaurants Utrecht, September the 23th 2011

Results (Kinnula V et al Prim Care Resp J 2011;20(2): ) 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 : males 4.7%, females 2.2% : 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 Utrecht, September the 23th 2011 Number/ Hospital days per Men years National Institute for Health and Welfare

Smoking among adults in Finland Utrecht, September the 23th 2011 p<0.001 Y 2010 M 23% F 16% National Institute for Health and Welfare

Retirements due to COPD Social Insurance Institution Utrecht, September the 23th 2011 Retirements due to all

Mortality due to COPD YearAllMen% of all Utrecht, September the 23th 2011 Statistic Finland

Costs due to COPD in Finland milj eur Medicines + Hosp.treat.+ Out patient Tynkkynen et al 2009 Utrecht, September the 23th %

Costs due to COPD in Finland milj eur Medicines + Hosp.treat.+ Out patient Tynkkynen et al 2009 Utrecht, September the 23th %

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