Medical Affairs Respiratory, Field Based Medicine-Respiratory, Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, CT 06877, USA.
Int J Chron Obstruct Pulmon Dis. 2012;7:437-45. doi: 10.2147/COPD.S31418. Epub 2012 Jul 11.
Questionnaires are available to identify patients at risk for several chronic diseases, including COPD, but are infrequently utilized in primary care. COPD is often underdiagnosed, while at the same time the US Preventive Services Task Force recommends against spirometric screening for COPD in asymptomatic adults. Use of a symptom-based questionnaire and subsequent handheld spirometric device depending on the answers to the questionnaire is a promising approach to identify patients at risk for COPD. Screening, Evaluating and Assessing Rate CHanges of diagnosing respiratory conditions in primary care 1 (SEARCH I) was a prospective cluster-randomized study in 168 US primary care practices evaluating the effect of the COPD-Population Screener (COPD-PS™) questionnaire. The effect of this questionnaire alone or sequentially with the handheld copd-6(TM) device was evaluated on new diagnoses of COPD and on respiratory diagnostic practice patterns (including referrals for pulmonary function testing, referrals to pulmonologists, new diagnoses of COPD, and new respiratory medication prescriptions). Participating practices entered a total of 9704 consecutive consenting subjects aged ≥ 40 years attending primary care clinics. Study arm results were compared for new COPD diagnosis rates between usual care and (1) COPD-PS plus copd-6 and (2) COPD-PS alone. A cluster-randomization design allowed comparison of the intervention effects at the practice level instead of individuals being the subjects of the intervention. Regional principal investigators controlled the flow of study information to sub-investigators at participating practices to reduce observation bias (Hawthorne effect). The results of SEARCH I, to be published subsequently, will provide insight into the real world utility of the COPD-PS as well as two-stage COPD case finding with COPD-PS and copd-6.
调查问卷可用于识别患有多种慢性疾病（包括 COPD）的患者，但在初级保健中很少使用。COPD 常常被漏诊，而与此同时，美国预防服务工作组建议不对无症状成年人进行 COPD 的肺量计筛查。使用基于症状的问卷和随后根据问卷答案使用手持式肺量计设备，是识别 COPD 高危患者的一种很有前途的方法。在 168 家美国初级保健诊所进行的一项前瞻性聚类随机研究——筛查、评估和评估初级保健中呼吸系统疾病诊断率 1（SEARCH I），评估了 COPD-人群筛查器（COPD-PS™）问卷的效果。单独使用该问卷或与手持式 copd-6（TM）设备连续使用对 COPD 的新诊断和呼吸诊断实践模式（包括肺功能测试转诊、肺病专家转诊、COPD 的新诊断和新的呼吸药物处方）的效果进行了评估。参与的实践共纳入了 9704 名连续同意参加初级保健诊所的年龄≥40 岁的连续患者。研究组结果比较了常规护理与（1）COPD-PS 加 copd-6 和（2）COPD-PS 单独使用时新的 COPD 诊断率。聚类随机设计允许在实践层面而不是个体层面比较干预效果，从而减少观察偏倚（霍桑效应）。SEARCH I 的结果将随后公布，这将深入了解 COPD-PS 的实际应用以及 COPD-PS 和 copd-6 两阶段 COPD 病例发现。
