Department of Respiratory Medicine and Allergology, Lund University Hospital, SE-222 41 Lund, Sweden.
Respir Med. 2010 Mar;104(3):404-11. doi: 10.1016/j.rmed.2009.10.007. Epub 2009 Dec 5.
To map out-patients with Chronic Obstructive Pulmonary Disease (COPD) with special reference to patients suffering from acute exacerbations, and to describe COPD health care structure and process in Swedish clinical practice in a real life setting.
Retrospective, non-interventional, epidemiological survey.
141 hospital based out patient clinics (OPC, n=30) and primary health care clinics (PC, n=111) were included in the structure evaluation.
1004 COPD diagnosed patients from 100 of the centres (OPC, n=26) participated in the process evaluation.
All Swedish OPC (n=40) and a random sample of 180 PC were asked to answer a questionnaire regarding COPD care. In addition, data from 10 randomly selected patients with a documented COPD disease were analysed from the centres.
Spirometers were available at all OPCs and at 99% of the PCs. Spirometry had been performed in 52% of PC-patients and in 89% of OPC-patients during the last 2 years prior to the study. More severe patients, as judged by investigator and lung function data, were treated at OPCs than at PCs. Physiotherapists, occupational therapists and dieticians were available at >80% of centres. Exacerbation rate was higher at PCs without a specialized nurse, 2.2/year versus 0.9/year at centres with a specialized nurse.
Special attention to COPD, marked by a specialised nurse in primary care improves the quality, as assessed by a lower number of exacerbations. The structure of COPD care in Sweden for diagnosed individuals seems satisfactory, but could be improved mainly through higher availability and educational activities.
描绘慢性阻塞性肺疾病（COPD）门诊患者，特别是急性加重期患者，并描述瑞典临床实践中 COPD 保健结构和流程。
回顾性、非干预性、流行病学调查。
纳入了 141 家基于医院的门诊诊所（OPC，n=30）和初级保健诊所（PC，n=111）进行结构评估。
100 个中心的 1004 名 COPD 诊断患者（OPC，n=26）参与了流程评估。
所有瑞典 OPC（n=40）和随机抽取的 180 个 PC 被要求回答一份关于 COPD 护理的问卷。此外，从中心随机选择了 10 名有记录的 COPD 疾病患者的数据进行分析。
所有 OPC 都配备了肺量计，99%的 PC 也配备了肺量计。在研究前的最近 2 年内，52%的 PC 患者和 89%的 OPC 患者进行了肺功能检查。根据研究者和肺功能数据判断，更严重的患者在 OPC 接受治疗，而不是在 PC 接受治疗。超过 80%的中心都有物理治疗师、职业治疗师和营养师。没有专门护士的 PC 中，加重率更高，为 2.2/年，而有专门护士的中心为 0.9/年。
在初级保健中，特别关注 COPD，由专门护士负责，可以提高质量，表现为加重次数减少。瑞典 COPD 诊断患者的保健结构似乎令人满意，但可以通过提高可用性和教育活动来进一步改善。
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