[Available resources for the management of chronic obstructive pulmonary disease exacerbations in Spain]

Chronic obstructive pulmonary disease exacerbations (COPDE) lead to a high use of healthcare resources. This study assesses the healthcare and organisational resources of Spanish health care centres for the management of COPDE at different care levels (Primary Care (PC), Respiratory Diseases, Internal Medicine, and Emergency Departments), and compare with current recommendations.

An observational study was carried out through telephone interviews to General Practitioners, Chest Diseases, Internal Medicine, and Emergency Department doctors.

A total of 284 doctors were interviewed. According to their responses, at PC centres there is a high availability of pulse oximetry (98.9%) and electrocardiograph (100%), and a low availability of Chest X-Ray (19.1%), or urgent laboratory tests (17.0%) in sites. In hospital wards, non-invasive mechanical ventilation (NIV) availability was 76.1%, with only a 69.7% of nursing staff properly trained in its use. Respiratory intermediate care units (RICUs) were available in 18.3% of public hospitals versus 41.7% of private hospitals. Specific training for COPDE management was received by 47.9% of Emergency Department doctors in the previous year. Only 31.9% of PC centres had specific protocols for referring patients to specialists. More than 35% of PC centres and hospitals do not have their electronic medical records integrated with other healthcare levels.

In general terms, there are sufficient resources available in Spanish healthcare centres. However, several areas of improvement were identified, such as an insufficient level of electronic medical record integration between healthcare levels, limited implementation of RICUs in public hospitals, and deficiencies related to specific training in NIV management.