PosiHealth, Inc., Ellicott City, Maryland, USA.
COPD. 2012 Feb;9(1):73-80. doi: 10.3109/15412555.2011.631957.
Chronic obstructive pulmonary disease (COPD) is the third-leading cause of death in the United States. Despite clinical practice guidelines endorsed by national organizations, the management of COPD deviates from guideline recommendations. Patients with COPD are frequently underdiagnosed and misdiagnosed, due in large part to the lack of spirometry testing. When diagnosed, about one third of patients are not receiving any COPD-related drug therapy. Factors that contribute to suboptimal management include provider, patient, and system factors. Physician factors such as understanding and attitude toward the disease, and awareness of guidelines, may affect appropriate management of COPD. Patient factors include medication non-adherence, understanding of the disease, severity of their symptoms, and access to medications. System factors such as insurance coverage may limit aspects of COPD care. To overcome clinical inertia, a multifaceted approach is required. Provider and patient education, the use of health informatics, changes in provider work-flow and the recent development of performance measures, such as the use of spirometry in patients with COPD, can improve the delivery of recommended care for COPD patients.
慢性阻塞性肺疾病（COPD）是美国的第三大致死原因。尽管得到了国家组织认可的临床实践指南，但 COPD 的管理仍偏离了指南建议。由于缺乏肺量计测试，COPD 患者经常被漏诊和误诊。当被诊断出患有 COPD 时，约有三分之一的患者没有接受任何 COPD 相关药物治疗。导致管理不善的因素包括提供者、患者和系统因素。医生的因素，如对疾病的理解和态度，以及对指南的认识，可能会影响 COPD 的适当管理。患者因素包括药物不依从、对疾病的理解、症状的严重程度以及药物的获取。系统因素，如保险范围，可能会限制 COPD 护理的某些方面。为了克服临床惰性，需要采取多方面的方法。提供给医生和患者的教育、使用健康信息学、改变医生的工作流程以及最近开发的绩效指标，例如在 COPD 患者中使用肺量计，可以改善 COPD 患者的推荐护理的提供。
