HEALTHCARE DELIVERY
(non-invasive ventilation, pulmonary rehabilitation and controlled oxygen treatment). Interventions that will have impact as part of a combined approach include prevention and earlier and accurate diagnosis. Significant improvements in mortality for lung cancer can only be made by earlier diagnosis and smoking cessation in the long run. People with lung cancer normally present with common respiratory symptoms and these patients are nearly always seen by a respiratory physician for diagnosis before referral to oncologists. Many are admitted as an emergency because the correct diagnosis is not made. It is vital, therefore, that emphasis is put on early and accurate diagnosis of any unusual respiratory symptoms. An estimated two million people have undiagnosed and untreated COPD.3 The recently published COPD: Who
Cares? report, published by the National Chronic Obstructive Pulmonary Disease (COPD) audit programme,4
found
that standards of care for patients with COPD have improved overall, but wide variation remains and some hospitals are still not meeting national service standards. The National COPD Audit Programme is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit Programme (NCA). The audit programme is led by the Royal College of Physicians. The audit identified that there have been significant improvements in COPD care since 2008, including an increase in the average number of respiratory consultants from three to four per hospital and improvement in the availability of palliative care services (50% to 87%). The management of patients with respiratory failure has improved and there is better access for patients with
COPD to teams who can support an early discharge from hospital.
However, unacceptable variation in COPD services remains in patient access to specialist care. The audit recommended that all patients admitted with a COPD exacerbation (flare up) should be cared for by respiratory specialists on a respiratory ward which will enable the patient to receive, and benefit from specialist care.
Commenting on currently COPD
services in the UK, Dr Robert Stone, COPD audit clinical lead for secondary care said: “More patients have access to supported discharge teams and assisted ventilation services are better organised. However, many patients in England and Wales are still unable to access specialist respiratory care on the right ward from the respiratory team. The availability of smoking cessation services and access to spirometry results is inadequate. The way we manage patients’ discharge from hospital needs to improve.”
Conclusion The WHO report states that all countries need to set national NCD targets need and be accountable for attaining all of the nine global targets that have been set by the WHO. These targets, says the WHO, give a clear signal of where the world can be by 2025 in relation to NCDs. All countries need to establish a monitoring framework to track progress in attaining them. Since the global targets focus on a limited set of key NCD outcomes, setting national targets and implementing policies and interventions to attain them will enable countries to make the best use of resources. For best results, lessons learnt from implementation should be rapidly incorporated in decision-making, through operational research.
Key global
NCD statistics • NCDs currently cause more deaths than all other causes combined and NCD deaths are projected to increase from 38 million in 2012 to 52 million by 2030.
• Four major NCDs (cardiovascular diseases, cancer, chronic respiratory diseases and diabetes) are responsible for 82% of NCD deaths.
• Approximately 42% of all NCD deaths globally occurred before the age of 70 years; 48% of NCD deaths in low- and middle-income countries and 28% in high-income countries were in individuals aged under 70 years.
References 1 Public Health England (2014). Adult obesity and type 2 diabetes.
https://www.gov.uk/government/uploads /system/uploads/attachment_data/file/ 338934/Adult_obesity_and_type_2_ diabetes_.pdf (accessed 20.02.2015) 2 The Organisation for Economic Co-operation and Development. Health at a glance: Europe 2014.
http://www.oecd.org/health/health- at-a-glance-europe-23056088.htm. (Accessed 20/02/2015) 3 Healthcare Commission (2006). Clearing the air: a national study of COPD.
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4 Royal College of Physicians (2014). COPD: who cares?
https://www.rcplondon.ac.uk/ projects/secondary-care- workstream#attachments. (accessed 20/10/2015)
Life expectancy improvements for people with type 1 diabetes
Researchers at Dundee University and Scottish Diabetes Research Network found that people with type 1 diabetes die significantly younger than the general population. However, it also identified an improvement in the life expectancy figures of this sector. Estimated life expectancy in a Scottish cohort with type 1 diabetes, based on data from 2008 through 2010, indicated an estimated loss of life expectancy at age 20 years of approximately 11 years for men and 13 years for women, compared with the general population without type 1 diabetes.1
The improvement has been linked to major medical advances in the treatment of type 1 diabetes over the last 30 years.
62 THE CLINICAL SERVICES JOURNAL
Commenting on the report, Sarah Ward, deputy national director of Diabetes Scotland, said: “This large study adds to our understanding of the serious impact of type 1 diabetes on length of life. The suggested increase in life expectancy is likely due to the improvements we have seen in diabetes care over the last 20 to 30 years, such as home blood glucose testing, earlier detection of diabetes and management of complications. The study looked at the cases of over 24,000 people with type 1 diabetes who were aged 20 or older between 2008 and 2010. It found that 47% of men and 55% of women with the condition survived to age 70, compared to 76% of men and 83% of women without it. On average,
men with diabetes lived for 46.2 further years after turning 20, compared to 57.3 years for men without it. Average life expectancy for women with the condition from the age of 20 was an additional 48.1 years, compared to 61 years among women without it. One of the main factors in the reduced life expectancy for people with type 1 diabetes was related to ischaemic heart disease (lack of oxygen to blood vessels), while kidney disease was also a common cause. Reference
1 Livingstone S J et al. Estimated life expectancy in a Scottish cohort with type 1 diabetes, 2008-2010. JAMA. 2015 Jan 6;313(1):37-44.
APRIL 2015
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