The Launch of the MOH Clinical Practice Guidelines On Chronic Obstructive Pulmonary Disease

12 Nov 2006

By Prof K Satku, Director of Medical Services

Venue: Raffles Hotel, The Ballroom

Dr Tan Boon Yeow, Chairman of the workgroup for the clinical practice guidelines on chronic obstructive pulmonary disease;

Dr Ong Kian Chung, President of the Chronic Obstructive Pulmonary Disease Association (Singapore);

Distinguished Guests, Ladies and Gentlemen

It gives me great pleasure to be here this afternoon at the launch of the Ministry of Health clinical practice guidelines on chronic obstructive pulmonary disease.

Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease, or COPD, is a major cause of morbidity and mortality worldwide. It is the fourth leading cause of death in the world and ranks thirteenth in terms of morbidity, as measured in disability-adjusted life years lost. According to the WHO Global Burden of Disease Study, by 2020, it will be the fifth leading cause of disability-adjusted life years lost.

In Singapore, COPD is the seventh leading cause of death today and morbidity due to this disease is rising. In 2005, over ten thousand (10,205) admissions to hospital were due to COPD and its associated conditions.

It is therefore timely that this set of guidelines has been developed to help guide our doctors in the management of their patients with COPD. These guidelines cover not only the diagnosis and management of stable COPD, but also include sections on managing acute exacerbations, air travel, surgery in COPD patients and end-of-life care. I would like to take this opportunity to thank Boon Yeow and his multidisciplinary team for the time and effort they have contributed to developing these guidelines, which, I am sure, will be a great help to doctors who manage COPD patients.

New system of grading recommendations in MOH Clinical Practice Guidelines

This is the 48th set of guidelines, including revisions of previously published guidelines, to be published in the MOH series of clinical practice guidelines. Our intention in facilitating the development of these guidelines is to provide guidance to doctors in Singapore on what constitutes scientifically proven and effective clinical practice. If these guidelines are to be useful, they need to be valid and reliable; for credibility and accountability, they also need to be seen to be developed in a rigorous and methodologically robust manner.

From the start, we had modelled our own CPG development programme after that of the Scottish Intercollegiate Guidelines Network, or SIGN, one of the leaders in the methodology of this field. This included the adoption of their system of grading guideline recommendations, which is intended to be a quick reference for the CPG user to let them know the strength of the evidence that supports the recommendation. Since then, SIGN has itself updated its system of grading. As part of the ongoing improvements in the MOH CPG programme, our CPGs will be adopting the newer system of grading. The COPD guidelines will be the first set to be published using the new system of grading. I understand that one of the presentations today will explain the changes in the system and what it means for the CPG user. 

Implementation of guideline recommendations

However good the methods used to develop the guidelines, and however strong the evidence that supports the recommendations made, the value of guidelines is only realised when they are put into practice. While the expert workgroup does its best to ensure that the guidelines are properly developed, and the Ministry ensures that they are widely disseminated in a variety of media including electronic versions for your handheld computers or PDAs, ultimately, implementation of guidelines can only be carried out by you, the guideline users.   

I would challenge you, the doctors who have patients with COPD, to treat these guidelines as more than another reference book that you browse through once when you get it and then put on your shelf. If you do not already have it in your practice, you may find it useful to draw up a simple protocol or checklist for your COPD patients based on the recommendations and algorithms in the guidelines. This will help remind you of important steps in managing your patients. The guidelines also contain clinical quality indicators that you can use to monitor your practice and to gauge quality of care. These are based on important recommendations in the guidelines. You could do a baseline check on your patients with COPD - how many are still smoking? How many have been offered annual influenza vaccination? Checking the numbers a year later will help you assess how well you are doing on those recommendations.

Conclusion

To conclude, I hope you will learn much from this afternoon's sessions. I would also like to add that we are now starting to record the presentations at our CPG launches. The slides and sound files will subsequently be made available at our MOH website. Please let your colleagues, who were not able to come today, know about this and encourage them to download the files for viewing and listening to at their leisure. Thank you.