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Geographic variation in long-term oxygen therapy in Denmark : factors related to adherence to guidelines for
T J Ringbaek1, P Lange, K Viskum
1Department of Respiratory Medicine, University Hospital of Copenhagen, Hvidovre Hospital, Denmark. Ringbaek@dadlnet.dk
Study Objectives:
To evaluate regional differences in adherence to guidelines for long-term oxygen therapy (LTOT) in Denmark and to determine factors related to compliance with these guidelines.
Design:
Cross-sectional study and analysis of a nationwide database (Danish Oxygen Register).
Setting:
Denmark.
Patients:
In November 1994, 1,354 COPD patients were receiving LTOT in Denmark.
Measurements And Results:
Among 16 counties, the prevalence of LTOT for COPD varied from 14 to 53 per 100,000. The prevalence was highest in counties where general practitioners (GPs) were prescribing LTOT. Adherence to national guidelines for LTOT was found in 34.4% of the patients for the whole of Denmark and varied regionally from 14 to 63%. Mean compliance with guidelines was 5.3 (range, 2.9 to 9.1) times as likely if the oxygen was prescribed by a pulmonary department compared to LTOT initiated by a GP.
Conclusions:
Marked geographic variations in compliance with LTOT guidelines are present even in a small country as Denmark. In general, the adherence to the guidelines is poor, especially when non-chest physicians prescribe LTOT. We therefore recommend that local and national thoracic societies together with health organizations responsible for treatment should play a more forceful role in implementing the guidelines. This could be done by enhanced educational efforts, by monitoring of adherence, or even by centralizing the prescription right to departments with pulmonary physicians.
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