The effectiveness gap in COPD: a mixed methods international comparative study

BACKGROUND: There has been a large increase in treatment and in research on chronic obstructive pulmonary disease (COPD) from the common starting point of the original Global Initiative for Chronic Obstructive Lung Disease (GOLD) study. There is currently little evidence on the degree of similarity and difference between national programmes or on the linkage between research and policy. AIMS: To review the evidence on programme development and the effectiveness gap from the UK, France, Germany, and Finland. METHODS: Visits and literature reviews were undertaken for regional centres in Lancashire, Nord-Pas de Calais, and Finland, Eurostat data on mortality and hospital discharges were analysed, and telephone interviews were conducted in Nord-Rhein Westphalia. RESULTS: There have been very significant differences in programme development from the original GOLD starting point. The UK has national strategies but they are without consistent local delivery. The French Affection de Longue Durée (ALD) programme limits special help to at most 10% of patients and there is little use of spirometry in primary care. Germany has a more general Disease Management Programme with COPD as a late starter. Finland has had a successful 10-year programme. The results for the effectiveness gap on hospital discharges show a major difference between Finland (40.7% fall in discharges) and others (increases of 6.0–43.7%). CONCLUSIONS: The results show the need for a simpler programme in primary care to close the effectiveness gap. Such a programme is outlined based on preventing the downward spiral for high-risk patients.