初级保健医生网络与 COPD 诊断开放式肺量计计划的比较。

Comparison of a network of primary care physicians and an open spirometry programme for COPD diagnosis.

机构信息

Respiratory Medicine Department, University of Thessaly Medical School, Larissa, Greece.

出版信息

Respir Med. 2011 Feb;105(2):274-81. doi: 10.1016/j.rmed.2010.06.020.

DOI:10.1016/j.rmed.2010.06.020

PMID:20663655

Abstract

BACKGROUND

Early diagnosis of Chronic Obstructive Pulmonary Disease (COPD) remains the cornerstone for effective management. In this study we compared an open spirometry programme and a case-finding programme providing spirometry to high-risk subjects selected by primary care physicians.

METHODS

A network of primary care physicians was created after invitation and all participants received training on COPD and spirometry. The study team visited 12 primary care settings in each programme in a 1-year period. Spirometry was performed in all eligible participants. COPD diagnosis and classification was based on GOLD guidelines and evaluation by a chest physician.

RESULTS

Patients with acceptable spirometry were evaluated (n = 201 in the case-finding and n = 905 in the open spirometry programme). The proportion of newly diagnosed COPD was 27.9% in the case-finding programme compared to 8.4% in the open spirometry programme (p < 0.0001). The number needed-to-screen (NNS) for a new diagnosis of COPD was 3.6 in the case-finding programme compared to 11.9 in the open spirometry programme. The majority of newly diagnosed patients were classified in GOLD stages I an II. The average cost for a new diagnosis of COPD was 173 € in the open spirometry programme and 102 € in the case-finding programme.

CONCLUSIONS

A case-finding programme involving primary care physicians was more cost-effective for the identification of new cases of COPD compared to an open spirometry programme. The development of networks of primary care physicians with access to good quality spirometry and specialist consultation for early diagnosis of COPD is justified.

摘要

背景

慢性阻塞性肺疾病（COPD）的早期诊断仍然是有效管理的基石。在这项研究中，我们比较了一种开放的肺量计计划和一种通过初级保健医生选择高危人群提供肺量计的病例发现计划。

方法

在邀请后创建了一个初级保健医生网络，所有参与者都接受了 COPD 和肺量计方面的培训。研究小组在为期一年的时间里，在每个计划中访问了 12 个初级保健场所。对所有符合条件的参与者进行了肺量计检查。COPD 的诊断和分类基于 GOLD 指南，并由胸部医生进行评估。

结果

评估了可接受肺量计的患者（病例发现计划中 n = 201，开放肺量计计划中 n = 905）。病例发现计划中新增 COPD 的比例为 27.9%，而开放肺量计计划中为 8.4%（p < 0.0001）。病例发现计划中诊断 COPD 的新病例需要筛查的人数（NNS）为 3.6，而开放肺量计计划中为 11.9。大多数新诊断的患者被分类为 GOLD 阶段 I 和 II。开放肺量计计划中 COPD 新诊断的平均费用为 173 欧元，病例发现计划中为 102 欧元。