Meulepas Marianne A, Jacobs Johanna E, Lucas Annelies E M, Smeenk Frank W J M, Smeele Ivo, Bottema Ben J A M, Grol Richard P T M
Centre for Quality of Care Research (WOK), University Medical Centre, 6500 HB Nijmegen, The Netherlands.
Prim Care Respir J. 2006 Dec;15(6):337-41. doi: 10.1016/j.pcrj.2006.08.010. Epub 2006 Oct 27.
To investigate the feasibility of a primary care model to improve the management of COPD.
An intervention study on 1,497 patients with documented COPD from 22 general practices, involving 11 practice nurses and a COPD Support Service (CSS). Outcome measures included the successful delegation of tasks from general practitioners (GPs) to the CSS and practice nurse, and performance in daily practice according to the model components -- keeping a patient register with a recall system, periodical history taking and lung function measurements, asking diagnostic and therapeutic advice, and performing regular follow-up visits with education and counselling.
In the 22 general practices, all components of the model were performed systematically, with the exception of 'asking for diagnostic and therapeutic advice' which occurred in 10 practices only. Of the 1,497 patients, 374 (25%) were treated by chest physicians. Of the remaining patients 88% were included in the primary care model and 12% refused regular follow-up.
This primary care model for COPD management proved to be very feasible; GPs delegated the tasks, almost all patients were included in the control system, and a large majority of patients accepted follow-up according to the model.
探讨一种初级保健模式改善慢性阻塞性肺疾病（COPD）管理的可行性。
对来自22家普通诊所的1497例有记录的COPD患者进行干预研究，涉及11名执业护士和一个慢性阻塞性肺疾病支持服务（CSS）。结果指标包括从全科医生（GPs）成功将任务委托给CSS和执业护士，以及根据模型组件在日常实践中的表现——建立带有召回系统的患者登记册、定期病史采集和肺功能测量、寻求诊断和治疗建议，以及进行定期随访并提供教育和咨询。
在22家普通诊所中，该模型的所有组件都得到了系统执行，但“寻求诊断和治疗建议”仅在10家诊所中进行。在1497例患者中，374例（25%）由胸科医生治疗。其余患者中，88%被纳入初级保健模式，12%拒绝定期随访。
这种用于COPD管理的初级保健模式被证明非常可行；全科医生委托了任务，几乎所有患者都被纳入控制系统，并且绝大多数患者接受了根据该模型进行的随访。
