Lange Peter, Rasmussen Finn Vejlø, Borgeskov Hanne, Dollerup Jens, Jensen Michael Skov, Roslind Klaus, Nielsen Lill Moll
Head Physician, Department of Cardiology and Respiratory Medicine, Hvidovre Hospital, Denmark.
Prim Care Respir J. 2007 Jun;16(3):174-81. doi: 10.3132/pcrj.2007.00030.
We studied the quality of care for COPD patients in a large sample of general practices in Denmark. We focussed on whether participation by general practitioners (GPs) in an educational programme could enhance the use of spirometry in the diagnosis and staging of the disease and improve adherence to COPD guidelines.
We performed two audit surveys of GPs' patients' notes, one year apart, before and after an educational programme for participating GPs and their staff. A total of 154 GPs participated in the study. 2549 patient records were included in the first survey and 2394 in the second.
Based on analysis of all patient records, we observed a substantial improvement in the quality of care: recording of FEV1 improved from 52.7% of cases in the first survey to 71.4% in the second (p< 0.001). There was a significant improvement in the recording of body mass index and provision of smoking cessation advice, recommendation of physical activity, checking of inhalation technique, dietary instruction, and referral to pulmonary rehabilitation. We also found a decline in the use of inhaled corticosteroids in patients with mild COPD, from 60.2% in the first survey to 48.8% in the second. When analysing the results focussing on the performance of single GPs there was an improvement in quality, but this was less than the improvement for patients overall - suggesting that improvement in quality of care was not equally distributed throughout the GPs' practices.
We conclude that it is possible to improve the quality of COPD care by educating GPs and their staff.
我们在丹麦大量的普通医疗实践样本中研究了慢性阻塞性肺疾病（COPD）患者的护理质量。我们重点关注全科医生（GP）参与教育项目是否能增加肺活量测定在该疾病诊断和分期中的应用，并提高对COPD指南的依从性。
在为参与项目的全科医生及其工作人员开展教育项目之前和之后，我们相隔一年对全科医生的患者病历进行了两次审核调查。共有154名全科医生参与了该研究。第一次调查纳入了2549份患者记录，第二次纳入了2394份。
基于对所有患者记录的分析，我们观察到护理质量有了显著改善：第一秒用力呼气容积（FEV1）的记录从第一次调查中的52.7%提高到了第二次调查中的71.4%（p<0.001）。体重指数的记录、戒烟建议的提供、体育活动的推荐、吸入技术的检查、饮食指导以及转介至肺康复方面都有显著改善。我们还发现轻度COPD患者吸入性糖皮质激素的使用有所减少，从第一次调查中的60.2%降至第二次调查中的48.8%。在分析聚焦于单个全科医生表现的结果时，质量有了改善，但低于总体患者的改善程度——这表明护理质量的改善在全科医生的诊疗实践中分布并不均匀。
我们得出结论，通过对全科医生及其工作人员进行教育，有可能提高COPD护理的质量。
