基层医疗中慢性阻塞性肺疾病（COPD）管理的变化：EMMEPOC 研究。

Changes in management of chronic obstructive pulmonary disease (COPD) in primary care: EMMEPOC study.

机构信息

Servei de Pneumologia, Institut del Tòrax, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Villarroel 170, 08036-Barcelona, Spain.

出版信息

Respir Med. 2010 Jan;104(1):67-75. doi: 10.1016/j.rmed.2009.08.003.

DOI:10.1016/j.rmed.2009.08.003

PMID:20122630

Abstract

BACKGROUND

Changes in management of COPD in primary care were studied following a training exercise among Spanish general practitioners (GPs). The exercise involved dissemination of the Spanish Society for Pulmonology and Thoracic Surgery (SEPAR) guidelines. The use of a portable device to perform spirometry tests was evaluated to adequately categorize COPD and reduce other diagnostic interventions.

METHODS

A representative sample of GPs from general practices in Spain was recruited for the study. In phase I, GPs performed an initial evaluation of 5 patients with COPD. In phase II, GPs were randomly allocated to the following groups: 1) control group-G1 (GPs managing COPD according to usual clinical practice); 2) training group-G2 (dissemination of SEPAR guidelines); and 3) training group-G3 (dissemination of SEPAR guidelines and distribution of the Koko Peak Pro to measure FEV(1), FEV(6), and FEV(1)/FEV(6)).

RESULTS

Phase-I included 3254 physicians, who selected 16,024 patients. In phase II, 301 physicians in G1, 1182 in G2, and 1141 in G3 selected 1481, 5798, and 5556 patients respectively. Evaluation of the changes in COPD stratification according to the SEPAR guidelines showed that physicians in G1 adequately classified 60% of patients, compared to 69% in G2 and 88.5% in G3 (p<0.0001). On comparing groups G1 and G3, a significant reduction was seen in chest X-rays (from 42% to 32%, p=0.0002) and arterial blood gas studies performed (from 34% to 22%, p<0.0001).

CONCLUSIONS

The dissemination of the SEPAR guidelines and the utilization of the portable device for spirometry may improve management of COPD in primary care.

摘要

背景

在西班牙全科医生（GP）进行了一项培训活动后，研究了对 COPD 管理的变化。该培训活动涉及了西班牙呼吸病学和胸腔外科学会（SEPAR）指南的传播。使用便携式设备进行肺功能测试的方法，旨在对 COPD 进行充分分类并减少其他诊断干预措施。

方法

从西班牙的一般实践中招募了代表性的 GP 样本进行这项研究。在第一阶段，GP 对 5 名 COPD 患者进行了初步评估。在第二阶段，GP 被随机分配到以下组别：1）对照组-G1（根据常规临床实践管理 COPD 的 GP）；2）培训组-G2（传播 SEPAR 指南）；3）培训组-G3（传播 SEPAR 指南和分发 Koko Peak Pro 以测量 FEV1、FEV6 和 FEV1/FEV6）。

结果

第一阶段包括 3254 名医生，他们选择了 16024 名患者。在第二阶段，G1 中有 301 名医生，G2 中有 1182 名医生，G3 中有 1141 名医生，分别选择了 1481、5798 和 5556 名患者。根据 SEPAR 指南评估 COPD 分层的变化表明，G1 中的医生对 60%的患者进行了适当分类，而 G2 中的医生为 69%，G3 中的医生为 88.5%（p<0.0001）。比较 G1 和 G3 两组，胸部 X 光片（从 42%降至 32%，p=0.0002）和动脉血气研究的数量（从 34%降至 22%，p<0.0001）显著减少。