Guidelines for the Chronic Obstructive Pulmonary Disease DMP assessed by IQWiG in Germany

On behalf of the Federal Joint Committee (G-BA), the Institute for Quality and Efficiency in Health Care (IQWiG) has researched current evidence-based guidelines on the chronic obstructive pulmonary disease (COPD), summarized their recommendations and checked the need for updates for the COPD disease management program (DMP).

The guideline synopsis is based on the analysis of 15 international guidelines; a total of 470 recommendations (which were summarized in a total of 65 key statements) were included. As the National Supply Guideline (Nationale VersorgungsLeitlinie, NVL) regarding COPD is currently being revised and a new version is to be published around mid-2020, it has not yet been taken into account in the current report. Other German guidelines on COPD did not meet the inclusion criteria for guideline research by IQWiG.

As a result, IQWiG identified the need for an update of two key points: long-term oxygen therapy (LOT) and patient monitoring, which was not yet described as an independent care aspect in the DMP. It is recommended not to use intermittent oxygen therapy in patients after physical exertion. However, some statements of the international guidelines on the LOT cannot be applied to the German health system without further amendments because of different treatment approaches in terms of risk assessment or setting oxygen flow rates in the home.

In the case of monitoring, the key message provides concrete suggestions for implementing follow-up checks on patients. Telemonitoring use in a DMP COPD still has to be checked due to the diverse organizational, technical, and legal problems and the unclear evidence in the guideline recommendations.

There is also a potential need for updating discharge management: the international guidelines address important care tasks to mobile and multidisciplinary primary care teams. This form of care is still mostly uncommon in Germany.

Based on guidelines synopsis, DMP on chronic diseases are regularly adapted to the current state of medical knowledge. The preliminary results, the so-called preliminary report, were published by IQWiG in November 2019 and put up for discussion. After the end of the commenting process, the preliminary report was revised and sent to the client as a final report in April 2020. The written comments submitted were published in a separate document at the same time as the final report. The report was prepared in collaboration with external experts.

The full details in German can be found here.

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