Bertella Enrica, Zadra Alessandro, Vitacca Michele
Respiratory Rehabilitative Division Fondazione Salvatore Maugeri IRCCS, Via Giuseppe Mazzini, 129, Lumezzane, BS, 25066, Italy.
Multidiscip Respir Med. 2013 Mar 19;8(1):24. doi: 10.1186/2049-6958-8-24.
GPs currently deal with COPD. The aim of this study was to review COPD management, data collection in medical records, and adherence to GOLD guidelines of 12 GPs from rural areas of Northern Italy and to assess changes after an educational program (EP).
From 2004 to 2008 medical records of patients, defined as COPD by GPs, were analyzed. Data collection in terms of tests prescription, Forced Expiratory Volume at first second (FEV1), smoking habits and actual drug treatment were reviewed at baseline and 1 year after EP.
437 patients were defined as COPD. GPs prescribed more chest X-rays than spirometry (99% vs. 74%, p<0.001), FEV1 was registered only in 50% of the population. GPs prescribed "correct" or "doubtful" (not related to FEV1) therapy in 38% and 56% of patients, respectively. Only smoking habit registration increased significantly (p<0.05) after EP.
Adherence to COPD Guidelines is suboptimal and data collection is poor. The EP did not change significantly GPs' practice: i) COPD diagnosis is largely clinical, ii) usage of spirometry is poor, GPs prescribe more chest X-rays iii) a small proportion of patients receive respiratory therapy, iv) therapy is often incorrect or not related to FEV1, v) correct clinical practice is influenced by the number of COPD patients and number of dedicated visits.
全科医生目前负责慢性阻塞性肺疾病（COPD）的治疗。本研究的目的是回顾意大利北部农村地区12名全科医生对COPD的管理、病历中的数据收集以及对慢性阻塞性肺疾病全球倡议（GOLD）指南的遵循情况，并评估一项教育计划（EP）后的变化。
分析2004年至2008年被全科医生定义为COPD的患者的病历。在基线和教育计划实施1年后，对检查处方、第一秒用力呼气量（FEV1）、吸烟习惯和实际药物治疗方面的数据收集情况进行了回顾。
437名患者被定义为COPD。全科医生开具的胸部X光检查比肺功能检查更多（99%对74%，p<0.001），仅50%的患者记录了FEV1。全科医生分别对38%和56%的患者开具了“正确”或“可疑”（与FEV1无关）的治疗。教育计划实施后，只有吸烟习惯的记录显著增加（p<0.05）。
对COPD指南的遵循情况不理想，数据收集也很差。教育计划并未显著改变全科医生的做法：i）COPD诊断很大程度上是临床诊断，ii）肺功能检查的使用情况不佳，全科医生开具的胸部X光检查更多，iii）一小部分患者接受呼吸治疗，iv）治疗往往不正确或与FEV1无关，v）正确的临床实践受到COPD患者数量和专门就诊次数的影响。
