Laniado-Laborín Rafael, Rendón Adrian, Alcantar-Schramm Juan Manuel, Cazares-Adame Rebeca, Bauerle Otto
Universidad Autónoma de Baja California, Tijuana, Mexico.
J Prim Care Community Health. 2013 Jul 1;4(3):172-6. doi: 10.1177/2150131913475817. Epub 2013 Jan 31.
Despite the popularity of chronic obstructive pulmonary disease (COPD) guidelines, studies have reported important deficits among primary care physicians (PCPs) with respect to diagnosis and treatment of COPD; as a consequence, COPD remains underrecognized and undertreated.
This was a multicenter pilot study to assess prescribing practices for COPD by PCPs according to COPD guidelines. This was a 2-phase study: In phase 1, PCPs from 27 Mexican cities, referred patients for evaluation, including spirometry and in phase 2, PCPs from 10 of those same cities were asked to answer a questionnaire on COPD practice guidelines.
A total of 2293 subjects were included in phase 1; 472 (20.6%) had a FEV1/FVC <70%. Only 39% of patients with 30% ≤ FEV1 < 50% and 22% with FEV1 <30% were receiving combination therapy (long-acting bronchodilator + inhaled steroid). In phase 2, we recruited 999 PCPs; 72.5% of them said that they had read a COPD guideline and 59.4% answered that they used one in their practice. When asked which guideline(s) they used, we had 86 different responses with GOLD (Global Initiative for Chronic Obstructive Lung Disease; 34.1%) being the most common, followed by GINA (Global Initiative for Asthma; 12.8%). When asked why they did not used a guideline, we got 33 different answers; "never read them" was the most frequent answer (41.8%) followed by "lack of access to them" (18.2%) and "not enough time to read them" (6.0%).
Despite the existence and availability of evidence-based guidelines, only a minority of primary health care COPD patients in Mexico are receiving state-of-the-art treatment at the primary care level.
尽管慢性阻塞性肺疾病（COPD）指南广受欢迎，但研究报告称，初级保健医生（PCP）在COPD的诊断和治疗方面存在重大不足；因此，COPD仍未得到充分认识和治疗。
这是一项多中心试点研究，旨在根据COPD指南评估初级保健医生对COPD的处方实践。这是一项分两阶段的研究：在第一阶段，来自墨西哥27个城市的初级保健医生转诊患者进行评估，包括肺活量测定；在第二阶段，来自其中10个相同城市的初级保健医生被要求回答一份关于COPD实践指南的问卷。
第一阶段共纳入2293名受试者；472名（20.6%）的第一秒用力呼气容积/用力肺活量（FEV1/FVC）<70%。在FEV1占预计值百分比（FEV1%）为30%≤FEV1<50%的患者中，只有39%接受联合治疗（长效支气管扩张剂+吸入性糖皮质激素），FEV1<30%的患者中这一比例为22%。在第二阶段，我们招募了999名初级保健医生；其中72.5%表示他们阅读过COPD指南，59.4%回答他们在实践中使用过指南。当被问及他们使用了哪些指南时，我们得到了86种不同的回答，其中慢性阻塞性肺疾病全球倡议（GOLD）指南（34.1%）最为常见，其次是全球哮喘防治创议（GINA）指南（12.8%）。当被问及他们不使用指南的原因时，我们得到了33种不同的回答；“从未阅读过”是最常见的回答（41.8%），其次是“无法获取”（18.2%）和“没有足够时间阅读”（6.0%）。
尽管有循证指南且可获取，但在墨西哥，只有少数初级保健中的COPD患者在初级保健层面接受了最先进的治疗。
