Jenkins Christine, Dickens Andrew P, Evans Alexander, Le Cheng Porsche, Heraud Florian, Hancock Kerry, Sharma Anita, Cochrane Belinda, Roussos Alexander, Le Lievre Chantal, Blakey John, Bosnic-Anticevich Sinthia, Carter Victoria, Catanzariti Angelina, Ghisla Clare, Hew Mark, Ko Brian, Le Thao, Leong Paul, McDonald Vanessa M, Lau Chi Ming, Perret Jennifer L, Pullen Rachel, Ranasinghe Kanchanamala, Soriano Joan B, Stewart Deb, van Melle Marije, Wiseman Russell, Price David
Head Respiratory Group, The George Institute and, UNSW, Sydney, Australia.
Optimum Patient Care Australia, QLD, Australia.
Lancet Reg Health West Pac. 2025 May 6;58:101555. doi: 10.1016/j.lanwpc.2025.101555. eCollection 2025 May.
BACKGROUND: We compared the management of patients with 'high-risk' COPD in Australia to national/international guidelines and quality standards, including the COllaboratioN on QUality improvement initiative for achieving Excellence in STandards of COPD care (CONQUEST). METHODS: Eligible patients in the Optimum Patient Care Research Database Australia were categorized as newly diagnosed (≤12 months after diagnosis), already diagnosed, or patients with potential undiagnosed COPD, in each year from 2015 to 2019. 'High-risk' patients had ≥2 COPD exacerbations/exacerbation-like events in the last 24 months. Descriptive statistics for 2019 are reported, along with annual trends. FINDINGS: In 2019, 11.3% (2608/22,985) of eligible patients met high-risk criteria. Most newly diagnosed high-risk COPD patients (71.3%) had no recorded lung function testing within 12 months of diagnosis. 63.6% of new COPD diagnoses had no evidence of supporting spirometry or chest CT, with the remainder having recorded chest CT only. 44.3% of already diagnosed high-risk patients had no recorded inhaled maintenance therapy, although this was recorded for 11.2% of potential undiagnosed patients. Smoking cessation support and pulmonary rehabilitation were recorded for <40% and ≤2% of diagnosed COPD patients respectively. INTERPRETATION: There is substantial opportunity to improve diagnosis, assessment and treatment of patients with COPD in Australia by identifying, reviewing and managing high-risk patients in accordance with evidence-based guidelines and CONQUEST standards. FUNDING: This study was conducted by Optimum Patient Care Australia Pty Ltd (OPCA) and was partially funded by OPCA and AstraZeneca Pty Ltd. No funding was received by the Observational & Pragmatic Research Institute Pte Ltd (OPRI) for its contribution.
背景：我们将澳大利亚“高危”慢性阻塞性肺疾病（COPD）患者的管理情况与国家/国际指南及质量标准进行了比较，其中包括旨在实现COPD护理标准卓越性的质量改进合作倡议（CONQUEST）。 方法：2015年至2019年期间，澳大利亚最佳患者护理研究数据库中的符合条件的患者每年被分类为新诊断（诊断后≤12个月）、已诊断或可能未诊断的COPD患者。“高危”患者在过去24个月内有≥2次COPD加重/类似加重事件。报告了2019年的描述性统计数据以及年度趋势。 结果：2019年，11.3%（2608/22985）的符合条件的患者符合高危标准。大多数新诊断的高危COPD患者（71.3%）在诊断后12个月内没有进行肺功能测试记录。63.6%的新COPD诊断没有支持性肺量计或胸部CT的证据，其余仅记录了胸部CT。44.3%的已诊断高危患者没有吸入维持治疗的记录，尽管11.2%的可能未诊断患者有此记录。分别有<40%和≤2%的已诊断COPD患者记录了戒烟支持和肺康复。 解读：通过按照循证指南和CONQUEST标准识别、审查和管理高危患者，澳大利亚在改善COPD患者的诊断、评估和治疗方面有很大机会。 资金：本研究由澳大利亚最佳患者护理私人有限公司（OPCA）进行，部分由OPCA和阿斯利康私人有限公司资助。观察与实用研究所有限公司（OPRI）未因其贡献获得资金。
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