Chronic care for COPD patients in Denmark.

COPD in Denmark The prevalence of chronic obstructive pulmonary disease (COPD) in Denmark is among the highest in the world [1]. This is mainly caused by a very high prevalence of smoking in both men and women throughout the latest 5 decades. Although the percentage of daily smokers among adult Danes has steadily declined to around 20% in 2011, COPD and other smoking related conditions are still a major health problem in Denmark. Based on spirometric findings from the Copenhagen City Heart Study and Copenhagen General Population Study, it has been estimated that around 400,000 Danes have COPD — corresponding to 7% of the total Danish Population, which comprises around 5.4 million [2]. It has also been estimated that around 40,000 individuals have severe or very severe COPD, defined as FEV1 below 50% of the predicted value. The mortality from COPD is also very high in Denmark. In 2010, app. 3,800 deaths were attributed to COPD, and in an additional 2,200 deaths COPD was acknowledged as a contributory factor, resulting in a total of app. 5,000 deaths, corresponding to app. 10% of all deaths [3]. The number of visits in general practice due to COPD is unknown, since Danish general practitioners, until now, have not performed any routine diagnostic coding describing the type of contact (diagnosis of the patient) in their practice. The drain of COPD on the Danish hospitals is, however, well described by means of a nationwide register covering all hospital contacts in Denmark. In 2010, there where around 24,000 acute hospital admissions and 53,000 scheduled visits to hospital outpatient clinics due to COPD [4]. In order to improve the care for COPD, the Danish Board of Health and the Danish Regions have launched a disease management program describing optimal care for COPD. These programs describe the role of three major players in Danish society responsible for the delivery of healthcare for individuals with COPD: general practice (family doctors = GPs), hospitals (specialized care), and municipalities [5, 6]. In this short review I will describe the collaboration between these three, with special focus on the role of GPs, but first I will give some brief details on the Danish healthcare system as such.