Patterns of care in the management of high-risk COPD in Australia (2015-2019): an observational study for the CONQUEST quality improvement program

Christine Jenkins; Andrew P Dickens; Alexander Evans; Porsche Le Cheng; Florian Heraud; Kerry Hancock; Anita Sharma; Belinda Cochrane; Alexander Roussos; Chantal Le Lievre; John Blakey; Sinthia Bosnic-Anticevich; Victoria Carter; Angelina Catanzariti; Clare Ghisla; Mark Hew; Brian Ko; Thao Le; Paul Leong; Vanessa M McDonald; Chi Ming Lau; Jennifer L Perret; Rachel Pullen; Kanchanamala Ranasinghe; Joan B Soriano; Deb Stewart; Marije van Melle; Russell Wiseman; David Price

doi:10.1016/j.lanwpc.2025.101555

Patterns of care in the management of high-risk COPD in Australia (2015-2019): an observational study for the CONQUEST quality improvement program

Lancet Reg Health West Pac. 2025 May 6:58:101555. doi: 10.1016/j.lanwpc.2025.101555. eCollection 2025 May.

Authors

Christine Jenkins¹, Andrew P Dickens², Alexander Evans², Porsche Le Cheng², Florian Heraud², Kerry Hancock³, Anita Sharma⁴, Belinda Cochrane^{5

6}, Alexander Roussos², Chantal Le Lievre², John Blakey^{7

8}, Sinthia Bosnic-Anticevich^{9

10

11}, Victoria Carter², Angelina Catanzariti¹¹, Clare Ghisla^{11

12}, Mark Hew^{13

14}, Brian Ko¹⁵, Thao Le², Paul Leong^{16

17}, Vanessa M McDonald¹⁸, Chi Ming Lau¹⁹, Jennifer L Perret²⁰, Rachel Pullen², Kanchanamala Ranasinghe^{21

22}, Joan B Soriano^{23

24}, Deb Stewart²⁵, Marije van Melle²⁶, Russell Wiseman²⁷, David Price²

Affiliations

¹ Head Respiratory Group, The George Institute and, UNSW, Sydney, Australia.
² Optimum Patient Care Australia, QLD, Australia.
³ Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia.
⁴ Platinum Medical Centre, Chermside, QLD, Australia.
⁵ Campbelltown Hospital, Sydney, Australia.
⁶ Western Sydney University, Sydney, Australia.
⁷ Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia.
⁸ Curtin University Medical School, Perth, Australia.
⁹ Woolcock Institute of Medical Research, 431 Glebe Point Road, Glebe, NSW 2037, Australia.
¹⁰ Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
¹¹ Medical Affairs, BioPharmaceuticals Medical, AstraZeneca, NSW, Australia.
¹² Novo Nordisk Medical Affairs, NSW, Australia.
¹³ Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, VIC, Australia.
¹⁴ Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
¹⁵ Victorian Heart Hospital, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, VIC, Australia.
¹⁶ Monash Heart, Monash Cardiovascular Research Centre and Monash University, Monash Health, Clayton, VIC, Australia.
¹⁷ School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia.
¹⁸ School of Nursing and Midwifery, The University of Newcastle, Australia.
¹⁹ Toukley Family Practice, 37-41 Canton Beach Road, Toukley, NSW 2263, Australia.
²⁰ Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia.
²¹ School of Medicine, Griffith University, Australia.
²² Cannon Hill Family Doctors, Cannon Hill, Australia.
²³ Facultat de Medicina, Universitat de les Illes Balears, Palma, Spain.
²⁴ Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
²⁵ School of Medicine, University of Tasmania, Churchill Ave, Hobart, TAS 7005, Australia.
²⁶ Nictiz, The Hague, Netherlands.
²⁷ Suncoast Medical Centre, Coolum Beach, QLD 4573, Australia.

Abstract

Background: We compared the management of patients with 'high-risk' COPD in Australia to national/international guidelines and quality standards, including the COllaboratioN on QUality improvement initiative for achieving Excellence in STandards of COPD care (CONQUEST).

Methods: Eligible patients in the Optimum Patient Care Research Database Australia were categorized as newly diagnosed (≤12 months after diagnosis), already diagnosed, or patients with potential undiagnosed COPD, in each year from 2015 to 2019. 'High-risk' patients had ≥2 COPD exacerbations/exacerbation-like events in the last 24 months. Descriptive statistics for 2019 are reported, along with annual trends.

Findings: In 2019, 11.3% (2608/22,985) of eligible patients met high-risk criteria. Most newly diagnosed high-risk COPD patients (71.3%) had no recorded lung function testing within 12 months of diagnosis. 63.6% of new COPD diagnoses had no evidence of supporting spirometry or chest CT, with the remainder having recorded chest CT only. 44.3% of already diagnosed high-risk patients had no recorded inhaled maintenance therapy, although this was recorded for 11.2% of potential undiagnosed patients. Smoking cessation support and pulmonary rehabilitation were recorded for <40% and ≤2% of diagnosed COPD patients respectively.

Interpretation: There is substantial opportunity to improve diagnosis, assessment and treatment of patients with COPD in Australia by identifying, reviewing and managing high-risk patients in accordance with evidence-based guidelines and CONQUEST standards.

Funding: This study was conducted by Optimum Patient Care Australia Pty Ltd (OPCA) and was partially funded by OPCA and AstraZeneca Pty Ltd. No funding was received by the Observational & Pragmatic Research Institute Pte Ltd (OPRI) for its contribution.

Keywords: Australia; COPD; Coordination of care; Diagnosis; Exacerbations; Spirometry; Treatment.