Construction of a comprehensive community management platform for prevention and treatment of chronic obstructive pulmonary disease and its application effect / 中国基层医药

ABSTRACT

Objective:To construct a comprehensive community management platform for prevention and treatment of chronic obstructive pulmonary disease (COPD) and evaluate its effectiveness and feasibility in the prevention and treatment of COPD.Methods:A comprehensive community management platform for prevention and treatment of COPD was established based on the information network. The platform mainly includes COPD screening, establishment of electronic health files of COPD patients living in the community, and hierarchical management of COPD patients. Patients who met COPD criteria were admitted by two community health centers (control and study groups, n = 1 000/group) with similar environments. In the control group, comprehensive community management platform for prevention and treatment of COPD was not established, and only diagnosis and conventional treatment were performed. In the study group, comprehensive community management platform was established to screen COPD patients, establish electronic health files of COPD patients, and hierarchically manage the COPD patients. All patients were followed up for 1 year. The number of acute exacerbations of COPD, treatment cost, the improvement in pulmonary function, dyspnea, and quality of life were compared between the two groups. The effects of the established comprehensive community management platform on prevention and treatment of COPD were analyzed. Results:One-year follow-up results revealed that an acute exacerbation of COPD occurred in 578 patients from the control group and 326 patients from the study group. The proportion of an exacerbation of COPD, the number of exacerbations of COPD, treatment cost in the study group were 32.60% (326/1 000), (1.52 ± 0.58), (2 014.21 ± 122.29) yuan, respectively, which were significantly lower than those in the control group [57.80% (578/1 000), (2.28 ± 2.15), and (4 201.34 ± 210.25) yuan, t = 12.34, 3.19, 21.24, all P < 0.05]. Before establishment of the comprehensive community management platform, there were no significant differences in pulmonary function, modified Medical Research Council (mMRC) dyspnea score, COPD assessment test (CAT) score between the two groups (all P > 0.05). In the control group, the ratio of forced expiratory volume in 1 second (FEV 1)/forced vital capacity (FVC), predicted FEV 1 value, mMRC dyspnea score, and CAT score were (60.32 ± 12.31)%, (63.65 ± 9.37)%, (1.89 ± 1.01) points, (18.82 ± 5.35) points, respectively after 1 year of treatment. There were no significant differences in these indexes between before and after 1 year of treatment ( t = 0.79, 0.87, 1.05, 0.83, all P > 0.05). In the study group, FEV 1/FVC ratio, predicted FEV 1 value, mMRC dyspnea score, and CAT score were (65.27 ± 13.59)%, (68.92 ± 10.67)%, (1.41 ± 0.72) points, (13.24 ± 5.21) points, respectively after 1 year of treatment. Significant differences in these indexes were found between before and after 1 year of treatment ( t = 3.28, 3.39, 4.17, 5.71, all P < 0.05). Conclusion:The established comprehensive community management platform is highly effective for prevention and treatment of COPD. It can effectively reduce the frequency of acute exacerbations of COPD, reduce treatment cost, improve pulmonary function, alleviate dyspnea, and improve quality of life.