Study objectives: To evaluate regional differences in
adherence to guidelines for long-term oxygen therapy (LTOT) in Denmark
and to determine factors related to compliance with these
Design: Cross-sectional study and analysis
of a nationwide database (Danish Oxygen Register).
Patients: In November
1994, 1,354 COPD patients were receiving LTOT in Denmark.
Measurements and results: Among 16 counties, the prevalence
of LTOT for COPD varied from 14 to 53 per 100,000. The prevalence was
highest in counties where general practitioners (GPs) were prescribing
LTOT. Adherence to national guidelines for LTOT was found in 34.4% of
the patients for the whole of Denmark and varied regionally from 14 to
63%. Mean compliance with guidelines was 5.3 (range, 2.9 to 9.1) times
as likely if the oxygen was prescribed by a pulmonary department
compared to LTOT initiated by a GP.
Conclusions: Marked geographic variations in compliance
with LTOT guidelines are present even in a small country as Denmark. In
general, the adherence to the guidelines is poor, especially when
non-chest physicians prescribe LTOT. We therefore recommend that local
and national thoracic societies together with health organizations
responsible for treatment should play a more forceful role in
implementing the guidelines. This could be done by enhanced educational
efforts, by monitoring of adherence, or even by centralizing the
prescription right to departments with pulmonary