ABSTRACT
Objective To evaluate effectiveness of prevention and treatment for patients with chronic obstructive pulmonary disease (COPD) for one year at community health-care service (CHS)centers. Methods A quasi-experiment design was used to evaluate effectiveness of community management for patients with COPD who visited and registered at Xiaokunshan and Xinbang CHS centers in Songjiang district of Shanghai in 2008, with COPD patients from Xiaokunshan community CHS center as management group and those from Xinbang as control. Measures for community management included training for local general practitioners in essential knowledge of COPD prevention and treatment, allocation of necessary drugs for COPD treatment, and health education for COPD patients and their family members. No special measures were taken for control group except routine treatment. Results A total of 132 patients were diagnosed as COPD according to their pulmonary function on 2008, 61 at Xiaokunshan and 71 at Xinbang CHS canters.One hundred and two patients, 47 at Xiaokunshan and 55 at Xinbang, finished one-year follow-up. Five patients from Xiaokunshan who were smokers at their first visits and three of them quitted smoking after oneyear management. Meanwhile, none of nine smoked patients from Xinbang quitted smoking in the same period. There was no statistically significant difference in symptom scores, pulmonary function, and forced expiratory volume at the first second (FEV1) between patients in the two groups during one-year follow-up.Average score of quality of life in patients at Xiaokunshan dropped to 39. 12 after one-year management from 46. 96 at their first visits, and that in patients at Xinbang increased to 62. 11 from 56. 55 (P＜0.01).Average six-minute walking distance (6-MWD) in patients at Xiaokunshan reduced to 354. 26 meters after one-year management from 361.66 meters at their first visits, meanwhile that in patients at Xinbang reduced to 351.18 meters from 398.07 meters (P =0. 008). Scores of functional dyspnea in patients at Xiaokunshan fell to 0.34 from 0.40 at their first visit, meanwhile that in patients at Xinbang increased to 1.00 from 0.95(P =0.038). During the one-year follow-up, 13 patients at Xiaokunshan and 53 at Xinbang visited emergency departments for treatment, and four at Xiaokunshan were hospitalized and none died, and five at Xinbang were hospitalized due to acute exacerbation of COPD and four of them died. Conclusions The study suggests that strengthening prevention and treatment for COPD patients at community level by general practitioners, patients themselves and their family members can improve their quality of life, reduce emergency visits and hospitalization, alleviate dyspnea symptoms and delay the decline of 6MWD.
ABSTRACT
Objective To understand awareness of basic knowledge on control and prevention for chronic obstructive pulmonary disease (COPD) among general practitioner in community health service centers. Methods Questionnaire survey was conducted among 593 general practitioners at 15 community health service centers in a district of Shanghai in the morning of February 26, 2008. Results Five hundred and forty-two of 593 ( 91.4% ) general practitioners surveyed knew that chronic obstructive pulmonary disease can be abbreviated as COPD, and 315 of them (53.1%) thought they knew the main contents of the "Guidelines for Prevention and Control of Chronic Obstructive Pulmonary Disease". No pulmonary function instrument was equipped at all 15 community health service centers surveyed, and 501 of 593 ( 84.5% ) general practitioners knew spirometry is gold standard for diagnosis of COPD. Only 115 ( 19.4% ) general practitioners knew that COPD can be categorized as acute exacerbation and stable stage. One hundred and sixty-three of them (27.5%) knew that drug therapy should be maintained in COPD patients for long term following effective treatment, 328 (55.3%) recognized that treatment for COPD patients was still needed in their stable stage, and 312 (52.6%) believed that antibiotics may not be necessary and 465 (78.4%) thought that inhalation therapy was the choice of treatment for acute exacerbation of COPD. Two hundred and thirty-five of them (39.6%) knew that oxygen inhalation should be more than 15 hours per day in regular family therapy. The investigation showed that 365 (61.6%) general practitioners had participated in training for COPD-related knowledge, only one or two times a year. Awareness of COPD knowledge was significantly poorer in rural practitioners than that in urban community ones. Conclusions Basic knowledge of prevention and treatment for COPD was seriously lack in general practitioners, so it is a necessity to strengthen training for them.
ABSTRACT
uate and should be standardized.