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

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.

1. Chuchalin A.G., Avdeev S.N., Aisanov Z.R. [Federal guidelines on diagnosis and treatment of chronic obstructive pulmonary disease]. Pul'monologiya. 2022; 32 (3): 356–392. DOI: 10.18093/0869-0189-2022-32-3-356-392 (in Russian).

2. Drapkina O.M., Kontsevaya A.V., Mukaneeva D.K. et al. [Forecast of the socioeconomic burden of COPD in the Russian Federation in 2022]. Pul'monologiya. 2022; 32 (4): 507−516. DOI: 10.18093/0869-0189-2022-32-4-507-516 (in Russian).

3. Zinnatullina A.R., Khamitov R.F. [Chronic obstructive pulmonary disease: significance of risk factors for frequent exacerbations requiring hospitalization]. Pul'monologiya. 2021; 31 (4): 446−455. DOI: 10.18093/0869-0189-2021-31-4-446-455 (in Russian).

4. Malykhin F.T., Baturin V.A. [Treatment compliance of elderly patients with chronic obstructive pulmonary disease]. Kazanskiy meditsinskiy zhurnal. 2014; 95 (5): 626−631. DOI: 10.17816/KMJ2204 (in Russian).

5. Mal'chikova S.V., Vidyakina E.E. [Assessment of compliance and life quality in patients with chronic obstructive pulmonory disease]. Vyatskiy meditsinskiy vestnik. 2016; 52 (4): 34−37. Available at: https://vyatmedvestnik.ru/index.php/vmv/issue/view/5/no4_52_2016 (in Russian).

6. Rehman A.U., Hassali M.A.A., Muhammad S.A. et al. The economic burden of chronic obstructive pulmonary disease (COPD) in Europe: results from a systematic review of the literature. Eur. J. Health Econ. 2020; 21 (2): 181−194. DOI: 10.1007/s10198-019-01119-1.

7. Agababyan I. R., Ismailov Zh. A., Turaev Kh. N. et al. [The importance of early detection of complications in chronic obstructive pulmonary disease]. Journal of Cardiorespiratory Research. 2022; 3 (4): 30−37. DOI: 10.5281/zenodo.7366140 (in Russian).

8. Balunov P.A., Khitrov A.N. [Pharmacoeconomic aspects of the use of bronchodilators in the management of COPD: real clinical practice]. Meditsinskiy sovet. 2018; (21): 96−104. DOI: 10.21518/2079-701X-2018-21-96-104 (in Russian).

9. Kharisov A.M., Berseneva E.A., Bereznikov A.V. et al. [Controlling the queue of work items in system of management of medical care quality in case of chronic obstructive pulmonary disease]. Nauchnyy zhurnal Baykal'skogo gosudarstvennogo universiteta. 2020; 11 (1): 4. DOI: 10.17150/2411-6262.2020.11(1).4 (in Russian).

10. Akulin I.M., Kukol' L.V., Pupyshev S.A. [The characteristics of organization of medical care under chronic obstructive disease of lungs]. Problemy sotsial'noy gigieny, zdravookhraneniya i istorii meditsiny. 2016; 24 (1): 21−27. Available at: https://cyberleninka.ru/article/n/osobennosti-organizatsii-meditsinskoy-pomoschi-pri-hronicheskoy-obstruktivnoy-bolezni-legkih (in Russian).

11. Kolosov V.P., Manakov L.G., Polyanskaya E.V. [Problems of the organization and management of the pulmonological care to the population of the Far Eastern Federal District]. Byulleten' fiziologii i patologii dykhaniya. 2020; (75): 8−20. DOI: 10.36604/1998-5029-2020-75-8-20 (in Russian).

12. Duenk R. G., Verhagen C., Dekhuijzen P. N. R. et al. The view of pulmonologists on palliative care for patients with COPD: a survey study. Int. J. Chron. Obstruct. Pulmon. Dis. 2017; 12: 299−311. DOI: 10.2147/COPD.S121294.

13. Luchkevich V.S., Avdeeva M.V., Samodova I.L. [Measurement in sociological research. Analysis and generalization of the results of empirical medical and sociological research: teaching aid]. St. Petersburg; 2016 (in Russian).