Programme no. 245-OP
Quality Improvement
Chronic obstructive lung disease in Norwegian general practice - a register based study
Øystein Hetlevik*1, Sturla Gjesdal2
1Dep. of Global health and primary care,University of Bergen,Bergen,Norway, 2Dep. of Global health and primary care,University of Bergen,Bergen,Norway
* = Presenting author
Objectives: To study the current role of Norwegian GPs in the care for patients with COPD at the start of the coordination reform, as a basis for future quality assessment.
Background: Among adults, surveys indicate a prevalence of chronic obstructive lung disease (COPD) of 5-10%. According to the coordination reform, introduced by the Norwegian Parliament in 2010, primary care is required to take more responsibility for these patients. To strengthen primary care, new services are introduced however partly without the GPs. National guidelines for COPD from 2012 recommend a yearly control including spirometry.
Results: During 2011, 2.8% of the Norwegian population ≥40 years, (N= 70 321) had a least one GP contact with COPD as the main diagnosis. According to the GPs’ diagnoses, 13% of the COPD patients also had depression and 7% anxiety during 2011. 32% had hypertension, 19% cardiovascular disease and 12% diabetes mellitus. 46% of the COPD patients had > 5 consultations in 2011 and 27% had a spirometry taken by a GP. Annual use of spirometry was associated with having a male GP (p<0.001), a GP approved specialist in general practice (p<0.001), belonging to a larger patient list (p<0.001), or a GP working in a lager municipality (p<0,001).
Material/Methods: Cross-sectional study based on the national GP claims’ database and the national GP database. In the Norwegian list patient system GPs are partly paid by fee-for-service. For each patient contact an invoice is sent, including the patient’s personal number, the main diagnosis, type of contact and information on medical procedures performed. Diagnoses from all GP claims for patients≥40 years in 2009-2011 were used to identify patients with COPD. Claims from all contacts with COPD patients in 2011 were used to assess the GP services utilised by this patient group and a selection of co-morbid conditions. Logistic regression analysis was used to identify predictors for annual use of spirometry at the GPs own office.
Conclusion: Norwegian GPs seem to keep close contact with patients diagnosed with COPD. Spirometry in the GPs’ own offices to monitor the disease is used less then recommended, especially among female GPs, GPs with few patients and GPs working in smaller municipalities.
Points for discussion: Routinely collected claims data probably underestimates the frequency of most medical conditions since only the main diagnosis is recorded.

Different attitudes to guideline recommendations and economical explanations of variation should be further clarified to improve quality of care.