Suchergebnisse

Background: The Swedish National Airway Register (SNAR) was initiated in 2013 to ensure and improve the quality of care for patients with asthma and COPD. Aim: To describe the development and design of SNAR, and to study the 2019 data to evaluate its potential utility related to improvement of quality of care. Methods: SNAR includes data from patients with asthma (both children and adults) and COPD from primary, secondary and tertiary care, and also, for COPD inpatient care. Data on diagnostic investigations (e.g. spirometry, blood sample, skin prick test), symptom-scores, comorbidities and prescribed treatments are registered. The registrations are entered manually by healthcare professionals, or directly transferred from electronic medical records to a web-based platform. Results: In 2019, 1000 clinics participated and data were directly transferred by about 88% of them. The register included data on 205,833 patients with asthma and 80,372 with COPD (of these, 5% had both diagnoses). Registrations of new patients and follow-up visits from primary and secondary/tertiary care in 2019 were completed for 75,707 patients with asthma (11,818 children 17 yr) and 38,117 with COPD. Depending on age and disease group, 43–77% had performed spirometry, 36–65% Asthma Control Test, and 60% COPD Assessment Test. The prevalence of current smoking was about 2% in adolescents, 10% in adults with asthma, and 34% in COPD. For these, smoking cessation support was offered to 27%, 38% and 51%, respectively. Overall, limited data were available on investigation of allergy, 6-min walk test, patient education and written treatment plans. Regarding asthma, sex-differences in disease management were evident. Conclusion: SNAR has cumulatively registered data from over 270,000 individuals, and the register is important for patients, caregivers, authorities, politicians and researchers to evaluate the effect of treatment and to ensure high and equal quality of care nationwide.

Respiratory diseases inflict a massive health burden worldwide, affecting >1 billion people. COPD, asthma, acute lower respiratory tract infections, tuberculosis and lung cancer are among the most common causes of severe illness and death globally [1]. Respiratory nurses are key members of the pulmonary healthcare team caring for people in acute settings, as well as in primary care, providing a wide range of interventions from ventilation to palliative care. Their specialised roles deliver both autonomous and prescribed interventions [2–6]. Worldwide, the recognition of respiratory nurses has been effective in improving the quality of care and patients' outcomes. In Australia and the USA, the scope and role of respiratory nurses has been well defined and established for 30 years [7]. In 2017, the European Respiratory Society (ERS) documented that allied respiratory professionals (ARPs) "are involved in the prevention, diagnosis, evaluation, treatment and management of respiratory diseases" [8]; however, the role of respiratory nurses within the ARPs was not clearly delineated. In the European Union (EU) only Denmark, Finland, Iceland, Norway, Portugal, Spain, Sweden and the UK have a formal respiratory specialisation for nurses, and the competences and education levels of respiratory nurses vary from one European country to another. Currently, there is a lack of consensus on the definition, role and activities of respiratory nurses. Thus, it is challenging to understand which specialist care would be best provided by respiratory nurses, and respiratory nursing roles in joint research projects and educational programmes remain unclear. It is imperative that respiratory nurses themselves define the scope of respiratory nursing and replace a general description such as "nurses taking care of people with pulmonary diseases", with the clarity needed for harmonised, tailored training and development plans. Defining and outlining the scope of practice, role and activities of respiratory nurses is of utmost importance to establish the components of advanced education for respiratory nurses. The specialisation, competences and responsibilities of respiratory nurses are still non-existent and not clearly defined in a majority of European countries (table 1) [9]. A unique curriculum for the specialisation of respiratory nurses needs to be created and implemented. Improving higher education, including basic nursing education, was the focus for development and implementation of the Bologna declaration, considered to be the most important reform to enable comparability in educational standards and quality that occurred in Europe in the past 30 years. It aimed to create a more coherent, compatible, comparable and competitive European higher education area to promote governmental inter-cooperation [10]. All countries that have signed the Bologna declaration agreed to strive for the consistency of educational systems across Europe. This agreement is especially important in respiratory nursing. Setting minimum standards of training and competence for specialties, such as in respiratory care, as well as basic nursing education, could help all European nursing schools to implement a coherent curriculum higher nursing education [11]. Initially, a consensus must be found on whether respiratory nurses' education should be an advanced course (<1 year full-time post-graduate), a diploma (1 year full-time post-graduate) or a master's degree (2 years full-time post-graduate).