Status, problems and directions of improvement of pulmonological care for patients with chronic obstructive pulmonary disease according to the results of multicenter medical and sociological study

Abstract

An expert analysis of existing organizational approaches at different levels of pulmonological medical care is needed to develop measures to improve pulmonological care for patients with chronic obstructive pulmonary disease. Aims: To conduct a multicenter medical and sociological study among pulmonologists to find priority areas and optimal ways to improve the organization of medical care for patients with chronic obstructive pulmonary disease (COPD). Methods. 181 pulmonologists from 23 regions of the Russian Federation were surveyed. Results. Pulmonologists believe that the actual prevalence (59.7%), disability rate (49.7%) and mortality rate (39.2%) associated with COPD are higher than official statistics in Russia. The most significant problems of the organization of pulmonological care are: defects in the organization of medical care at different levels, including insufficient quality of medical care (95.6%); lower quality of outpatient medical care compared to the inpatient care (p < 0.001); insufficient subsidized drug provision (69.6%); lack of dispensary follow-up (58.1%); insufficient rehabilitation measures (56.4%); diagnostic errors (53.4%); insufficient preventive measures (52.3%); long distance between specialized medical institution and the patient’s place of residence (41.4%); lack of continuum between the pre-hospital and hospital care (39.2%); lack of effective patient routing (37.1%); the high need of the regions in the medical and social programs to reduce morbidity and mortality from COPD (92.8%); insufficient contribution of the medical community to the adherence of COPD patients to prevention, treatment and rehabilitation; inadequate legal framework governing pulmonary care for COPD patients (29.3%). According to 97.7% of pulmonologists, COPD should be classified as a socially significant disease. This will allow for upscaling the programs aimed at prevention of COPD and reduction of the mortality rate and disability rate associated with COPD. Conclusion. The priority direction in the development of pulmonological care in Russia is improvement of regulatory and legal support with the development of more effective approaches to the provision of medical care to patients with COPD at all levels.