MEDICAL CARE for people with chronic respiratory disease, for which the Republic has the highest EU mortality rate, is haphazard with inconsistent access to essential services in both the community and hospitals, a major report has found.
The COPD (chronic obstructive pulmonary disease) strategy, a copy of which has been seen by The Irish Times, says patients cannot access hospital respiratory expertise when they need it, leading to unnecessary attendances at AE departments and avoidable hospital admissions.
COPD is a progressive disease leading to an obstruction to the flow of air in and out of the lungs resulting in difficulty breathing. About 440,000 people in Ireland have COPD.
According to the report, 86 per cent of GPs said they found it either difficult or impossible to rapidly access a hospital respiratory clinic on behalf of a patient with COPD whose condition was deteriorating. "The availability of such services can ensure that patients are cared for in the most appropriate setting, usually primary care, and receive the benefits of specialist advice that otherwise may necessitate hospital admission," the report states.
Just 10 of the Republic's acute hospitals have pulmonary rehabilitation programmes (PRP). As a result, a tiny proportion of people with COPD (about 350 patients per annum) can access PRPs, with waiting times of two to 18 months.
"Given the prevalence of COPD, it is clear that there is currently insufficient capacity to provide this essential service to large numbers of people with COPD," the report says.
The strategy, compiled by a national COPD group, including representatives from the HSE, the Department of Health, the Irish Thoracic Society (ITS) and the Irish College of General Practitioners, is based on original research and follows consultation with professional and patient groups. The report has been forwarded to HSE chief executive Prof Brendan Drumm.
It highlights deficiencies in people's ability to access smoking cessation services and it describes access to patient education and support as "patchy and variable". Geographic inequities identified in the report include a wide variation in the number of nebulisers (used to administer inhaled drugs at home) supplied by different local health offices. Specialist staffing is skewed in favour of Dublin, which has almost half of the Republic's 35 consultant respiratory physicians. And the average length of hospital stays for COPD patients varied from 8.5 days in the west to 13.5 days in Dublin south.
The strategy calls for a national steering respiratory group to be established at HSE management team level with the overall aim of developing "a community-based responsive, adaptable and flexible service" for patients.