Identifying the common barriers to optimal COPD care in Japan, Canada, England, and Germany through Evidenced Care Pathways

COPD was the third leading cause of mortality worldwide in 2019 (1), responsible for 3.23 million deaths (2). Improved understanding of the common barriers to care delivery could inform international approaches to improving care standards and patient outcomes.

Evidence Care Pathways (ECPs) were created to bring to life the story of how COPD care is currently delivered in Japan, Canada, England and Germany. Published epidemiological, clinical, and economic data was used to populate the ECPs. Thematic content analysis was performed on the clinician interviews (twenty-four respiratory healthcare professionals in primary and secondary care) to inform and validate the ECPs.

The results of this work published in the International Journal of Chronic Obstructive Pulmonary Disease identified three key themes relating to barriers to optimal COPD management across the countries: journey to diagnosis, treatment and management, and the impact of COVID-19. Presentation to healthcare with advanced COPD, low consideration of COPD by patients and healthcare professionals, and sub-optimal acute and chronic disease management were common across all countries. COVID-19 has negatively impacted disease management across the pathway – but has also opened opportunities for virtual consultations.

COPD is a significant public health issue that needs urgent prioritisation. The common barriers to optimal COPD care identified across the four studied countries highlight the continued need for strategies to optimise COPD care, particularly as the burden of COPD continues to grow.

The Evidenced Care Pathways for the four countries can be downloaded here. Please download this document and open it in a PDF reader such as Adobe for full functionality.

This study was funded and commissioned by AstraZeneca.

Meiwald A, Gara-Adams R, Rowlandson A, et al. Qualitative Validation of COPD Evidenced Care Pathways in Japan, Canada, England, and Germany: Common Barriers to Optimal COPD Care. Int J Chron Obstruct Pulmon Dis. 2022;17:1507-1521 https://doi.org/10.2147/COPD.S360983

References

1. WHO. The top 10 causes of death. Accessed October 22, 2021. https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death

2. WHO. Chronic obstructive pulmonary disease (COPD) fact sheet. Published 2021. Accessed August 18, 2021. https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)

© Aquarius Population Health 2021. For commercial use or distribution, please contact info@aquariusph.com.

Modelling the impact of using a DNA compared to mRNA HPV assay as part of the cervical screening programmes in Sweden and Denmark

Nearly all cases of cervical cancer are caused by 14 high-risk human papillomavirus (HR-HPV) genotypes. Denmark and Sweden are assessing the structure of their cervical cancer screening programmes and implementing HR-HPV screening in certain populations. While both DNA and mRNA assays have similar sensitivity, mRNA assays have been shown to have higher specificity resulting in fewer false-positive results.

We adapted a decision tree model from a previously published study in England to explore how the type of assay used to detect HR HPV infections in a screening programme may impact costs, patient follow-up, and resource use. The results showed the use of mRNA tests in cervical screening for women in Sweden or Denmark instead of DNA testing would result in cost savings and a decrease in the number of unnecessary cytology tests, unnecessary recall HR-HPV tests and unnecessary colposcopies compared to HR-HPV DNA testing and can be used to inform the implementation of screening programmes with benefits for health services and women.

presentation_icon


Dombrowski C, Weston G, Adams E. Modelling the impact of using a DNA compared to mRNA HPV assay as part of the cervical screening programmes in Sweden and Denmark. Poster presented at: EUROGIN International Multidisciplinary HPV Congress; 2021 May 30 – June 1; Virtual

Read Publication

Rapid testing and treatment for sexually transmitted infections improve patient care and yield public health benefits

With collaborators at Chelsea and Westminster NHS Foundation Trust, we estimated the impact of a rapid testing and result notification service for patients testing for sexually transmitted infections at the Dean Street Express clinic. We found that a rapid testing service for asymptomatic infections resulted in 8 days’ faster time to result notification for CT and/or NG which enables faster treatment, thus reducing infectious periods and leading to fewer transmissions, unnecessary partner attendances and clinic costs, compared with those attending an existing ‘standard’ sexual health clinic.

PublicationWhitlock GG, Gibbons DC, Longford N, et al. Rapid testing and treatment for sexually transmitted infections improve patient care and yield public health benefits
International Journal of STD & AIDS. First Published October 23, 2017
https://doi.org/10.1177/0956462417736431

 

Read Paper

 

Point-of-care tests for infectious diseases: Barriers to implementation across three London teaching hospitals

Our paper explores results of the acceptability and implementation issues of point of care tests (POCTs) in paediatric patients in three south London hospitals. Overall, we found that having a test result was thought to improve bed management and cohorting sick patients appropriately, reassure parents about their child’s condition, reduce hospital transmission, and rationalise further tests and treatment. Concerns focused on confidence about the test’s performance – particularly around false negatives not receiving proper management, how to manage discrepant results (i.e. the laboratory assay gave a different answer to the POCT), and training enough staff to run the test at the point of care.

Publication

Bustinduy AL, Jeyaratnam D, Adams EJ, et al. CLAHRC South London; Paediatric Infection Network. Point-of-care tests for infectious diseases: Barriers to implementation across three London teaching hospitals. Acta Paediatrica,  April 2017. DOI: 10.1111/apa.13867

Read Publication

Modelling the burden of non-muscle-invasive bladder cancer in Europe

Bladder cancer is relatively common in the EU. Most cases are non-muscle-invasive bladder cancer (NMIBC), classified into risk groups based on their chance of progression, which determines the frequency and duration of monitoring after treatment. We created a flexible tool to estimate the burden of NMIBC cases in eleven European countries and estimated the number of monitoring cystoscopies by risk group based on national and regional guidelines.

presentation_icon
Vecino-Ortiz AI, Glover RE, Adams EJ. Modelling the burden of non-muscle-invasive bladder cancer in Europe. European Association of Urology. 11-15 March 2016. Munich, Germany.

 

Read Publication

Mapping the diagnostic pathway for breast cancer in England and comparison to Europe

Breast cancer is the most common cancer in women in England and the second most common cause of cancer death. We mapped the breast cancer diagnostic pathway in England and rest of Europe and estimated the number of women transitioning through each step of the pathway, and the number of symptomatic women. We propose a new metric to discuss breast cancer screening, annual effective screening rate, to allow for comparison of the effectiveness of different breast cancer interventions across Europe.

presentation_icon
Adams EJ, Midha D, Glover R,  et al. Mapping the diagnostic pathway for breast cancer in England and comparison to Europe ISPOR 18th Annual European Congress. 7-11 November 2015. Milan, Italy.

 

Read Publication

Cervical screening and HPV testing: Opportunities for rapid tests

Problem:  Our client Cepheid has developed a rapid HPV PCR test that can be used as a point-of-care test (POCT). They wanted to understand where in the cervical cancer screening and treatment pathway the test would be most beneficial to patients and the healthcare system. This comes during a time of uncertainty about how best to screen women, and how to organise laboratory services around screening. It is also unclear how screening may differ across Europe and the burden of cervical disease.

 Approach:  We conducted a literature review of the evidence about the current national cervical screening programme in the UK. Then, we conducted 25 semi-structured interviews with key opinion leaders across the UK to gain additional insight about the pathway and the opportunities for using a POCT in the screening pathway. Results also contributed to a European tool to understand cervical cancer diagnosis and burden.

 Impact:  We have presented our findings at international conferences (EUROGIN 2015, IPC 2015), and results have helped our client as they communicate the opportunities and value of a POCT for HPV to their stakeholders and customers. We have engaged with the international community on the requirements for the creation of a standardised international cervical cancer data repository, to inform better evidence-based decision making.

 

Testimonial

“While perfectly responding to the originally given mission, the Aquarius team painted a comprehensive picture of how healthcare is really delivered currently in Europe. This opened up our minds to new ways of improving patient care. The Aquarius team under Elisabeth’s leadership is highly professional, very creative and great fun to work with, without ever taking short cuts. I cannot imagine better results for us.”

  • Dr Anne Postulka, Senior Director Medical & Economic Value, Cepheid

 

Related publications

presentation_iconAdams EJ, Glover R, Vecino A, Postulka A. Exploring the value of a rapid, on-demand test for the detection of human papillomavirus. 30th International Papillomavirus Conference. Lisbon, Portugal. September 17 -21, 2015.

 

presentation_iconAdams EJ, Glover R, Vecino A, Postulka A. How can European countries improve cervical cancer prevention for women? 30th International Papillomavirus Conference. Lisbon, Portugal. September 17 -21, 2015.

The cost of pelvic inflammatory disease and potential cost-savings of chlamydia screening

Problem: The POPI trial was a randomised control trial in South London estimating the incidence of pelvic inflammatory disease (PID) and the potential impact of screening for chlamydial infection on preventing PID. The study group wanted to know the costs to the health care system of managing PID, and what cost savings could be made through chlamydia screening.

Approach: We worked with the study team to define the question based on the data they had already collected during the trial, and then developed a strategy to answer it. This involved extracting data from patient notes and building a simple model in Excel to estimate the costs of care for women with PID. National costs were applied to local data, and we scaled up the results to estimate the potential cost savings, both locally and nationally.

 Impact: This work provided estimates of the cost of managing PID, which are useful to groups exploring the impact of delivering care to these patients and also for those wishing to explore the impact of interventions to avoid PID such as chlamydia screening. The results were published in Sexually Transmitted Infections, and has been cited many times in prestigious journals and authoritative reports and used in two modelling studies.

 

Testimonial

“Dr Adams is an excellent health economist, very clear thinking and easy to work with. She has original ideas and delivers on time. She designed the cost analysis for our trial, supervised the research assistant who assembled the relevant data and enabled publication in a high ranking journal.”

  • Dr Pippa Oakeshott, Professor of General Medicine, St Georges University

 

Related publications

publication_iconAghaizu A, Adams EJ, Turner KME, et al. What is the cost of pelvic inflammatory disease and how much could be prevented by screening for Chlamydia trachomatis? Cost analysis of the POPI (prevention of pelvic infection) trial. Sex Transm Infect 2011; 87:312-317.

Providing integrated HIV treatment and care for stable patients in general practice

We implemented a nurse-delivered integrated HIV and primary care service pilot study for stable patients in two local inner city general practices. Initial results from the patients in the study indicate that a novel model of HIV care with a greater emphasis on patient convenience appears to have high levels of patient satisfaction and favourable treatment outcomes; further work will analyse the costs and impact of the service.

presentation_iconAlexander H, Richards P, Brady M, et al. Providing integrated HIV treatment and care for stable patients in general practice. 21st Annual Conference of the British HIV Association. 21 – 24 April 2015, Brighton, UK

Read Publication

How can European countries improve cervical cancer prevention for women?

We conducted a literature review on cervical cancer incidence, screening algorithms and coverage across Europe. Data on the structure and provision of screening programmes are sparse, with large heterogeneity reported by sources. A lack of comparable data across countries makes it challenging for researchers and policy-makers to assess screening effectiveness and what is most beneficial for women. A central data repository could facilitate effectiveness and cost-effectiveness analyses to support the adoption of the best screening algorithm.

presentation_iconAdams EJ, Glover R, Vecino A, Postulka A. How can European countries improve cervical cancer prevention for women? 30th International Papillomavirus Conference. Lisbon, Portugal. September 17 -21, 2015.

 

Read Publication