Moore Pamela L
Physicians Practice, Baltimore, Maryland, USA.
Am J Med. 2007 Aug;120(8 Suppl 1):S23-7. doi: 10.1016/j.amjmed.2007.04.009.
The aim of this study was to observe how chronic obstructive pulmonary disease (COPD) is diagnosed and treated in primary care settings and to identify best practices. Researchers interviewed or visited physicians and staff at 25 primary care practices across the United States, focusing on small practices. All interviewers used a standard interview tool to capture anecdotal and quantitative data. It was discovered that primary care physicians underuse spirometry as a diagnostic tool, even when available in the office or clinic. Formal smoking-cessation programs are uncommon, as are outcomes measurements through clinical monitoring. Physicians reported not having enough time to improve performance, mainly owing to an average 15-minute patient visit allotment. Practice inefficiencies are responsible for many clinical shortcomings in COPD management. Although improving clinical understanding is important, it is equally important that overburdened and rushed primary care practices optimize workflow. This can be accomplished through better use of support staff and improved scheduling of spirometry testing in order to implement clinical guidelines without interfering with other essential practice tasks.
本研究的目的是观察慢性阻塞性肺疾病（COPD）在基层医疗环境中的诊断和治疗方式，并确定最佳实践方法。研究人员采访或走访了美国各地25家基层医疗诊所的医生和工作人员，重点关注小型诊所。所有采访者都使用标准采访工具来收集轶事性和定量数据。研究发现，基层医疗医生未充分利用肺活量测定法作为诊断工具，即便该设备在办公室或诊所中可用。正式的戒烟项目并不常见，通过临床监测进行结果测量的情况也不常见。医生们表示没有足够时间来提高工作表现，主要原因是平均每次患者就诊时间只有15分钟。实践效率低下是COPD管理中许多临床缺陷的原因。虽然提高临床认识很重要，但同样重要的是，负担过重且匆忙的基层医疗实践要优化工作流程。这可以通过更好地利用辅助人员和改进肺活量测定测试的安排来实现，以便在不干扰其他基本实践任务的情况下实施临床指南。
