Spirometry assessment, stepwise pharmacological management and speedy access to pulmonary rehabilitation are among the inclusions in new draft clinical care standards for COPD which have been released for consultation.

Drawn up by the Australian Commission on Safety and Quality in Health Care (ACSQHC), the draft standards apply to GPs, respiratory physicians and others at all levels of the health system and cover key aspects of care relating to the diagnosis and management of COPD, including exacerbations.

Comments are being sought from healthcare professionals, peak healthcare and consumer organisations, patients and any other interested parties.

The clinical care standard includes a set of indicators to support healthcare providers and local health services to monitor how well they implement the care described in the clinical care standard.

Different from a clinical guideline, it articulates 10 ‘quality statements’ on topics including diagnosis with spirometry, comprehensive assessments, education, pharmacological management of stable COPD and exacerbations and follow-up care after hospitalisation.

Regarding pulmonary rehabilitation, it declares anyone with symptomatic COPD should be referred to pulmonary rehab.

“If the person has been hospitalised for a COPD exacerbation, they are referred to a pulmonary rehabilitation program on discharge and commence the program within four weeks,” it adds.

Indicators for local monitoring are as follows:

Diagnosis with spirometry

Indicator 1a:

Proportion of patients with a diagnosis of COPD who have had spirometry.

Indicator 1b: Proportion of patients admitted for COPD whose diagnosis had not been confirmed with spirometry, who received spirometry while in hospital or in outpatient follow-up care.

Comprehensive assessment

Indicator 2a: Proportion of patients with COPD whose healthcare record includes 14 documentation of their history of exacerbations.

Education and self-management

Indicator 3a: Proportion of patients with COPD with a COPD action plan.

Vaccination and tobacco-smoking cessation

Indicator 4a: Proportion of patients with COPD who received an influenza vaccination in the last year.

Indicator 4b: Proportion of patients with COPD who received at least one dose of pneumococcal vaccination.

Indicator 4c: Proportion of patients with COPD whose current smoking status was recorded in their healthcare record.

Indicator 4d: Proportion of patients with COPD who reported they currently smoke tobacco, who were prescribed pharmacotherapy for smoking cessation.

Pharmacological management of stable COPD

Indicator 5a: Proportion of patients with COPD prescribed an inhaled medicine who had their inhaler technique assessed at least once in the last year.

Indicator 5b: Proportion of patients with COPD prescribed an inhaled corticosteroid who were not also prescribed dual long-acting bronchodilators.

Pharmacological management of COPD exacerbations

Indicator 6a: Proportion of patients with a COPD exacerbation who were prescribed an antibiotic, who met the clinical criteria for bacterial infection.

Indicator 6b: Proportion of patients with a COPD exacerbation who were prescribed an antibiotic, who were prescribed oral amoxicillin or doxycycline.

Indicator 6c: Proportion of patients admitted for an acute COPD exacerbation prescribed a short course of oral corticosteroids.

Oxygen and ventilatory support for COPD exacerbations

Indicator 7a: Proportion of patients with a COPD exacerbation who received controlled oxygen therapy where the target oxygen saturation levels of 88-92% were documented in the patient’s healthcare record.

Indicator 7b: Proportion of patients with signs of hypercapnic respiratory failure due to a COPD exacerbation who were assessed for non-invasive ventilation.

Indicator 7c: Proportion of patients with hypercapnic respiratory failure due to a COPD 23 exacerbation who received non-invasive ventilation.

Follow-up care after hospitalisation

Indicator 8a: Proportion of patients admitted for a COPD exacerbation whose discharge summary was sent to their general practitioner/practice on discharge from hospital.

Indicator 8b: Proportion of patients admitted for a COPD exacerbation seen for a follow-up assessment with their general practitioner within seven days of discharge from hospital.

Pulmonary rehabilitation

Indicator 9a: Proportion of patients with COPD referred to a pulmonary rehabilitation program.

Indicator 9b: Proportion of patients discharged from hospital after a COPD exacerbation who started a pulmonary rehabilitation program within four weeks of discharge.

Symptom support and palliative care

Indicator 10a: Evidence of local arrangements to enable timely access to palliative care and symptom support for people with COPD.

The local arrangement should specify:

• Processes to support clinicians to provide timely palliative care support, including after hospitalisation for an exacerbation
• Pathways to facilitate patient access to suitable clinicians or palliative care services to manage symptoms, address emotional, spiritual and practical needs and facilitate advance care planning
• Pathways to facilitate patient access to palliative care services that are available through Aboriginal Community Controlled Health Organisations (ACCHOs) and Aboriginal Medical Services (AMSs)
• Process to facilitate the involvement of Aboriginal or Torres Strait Islander Practitioners or Health Workers, cross-cultural health workers, and interpreters to align with patients’ needs and preferences
• Processes to support clinicians to deliver sensitive and culturally safe palliative care.

Indicator 10b: Proportion of patients admitted for a COPD exacerbation where the patient’s goals of care were documented in their healthcare record.

Interested parties have until midnight of 18 December to provide their feedback via the ACSQHC website.