Arne Mats, Emtner Margareta, Lisspers Karin, Wadell Karin, Ställberg Björn
Primary Care Research Unit, Karlstad, Sweden.
Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden;
Eur Clin Respir J. 2016 Nov 28;3:31601. doi: 10.3402/ecrj.v3.31601. eCollection 2016.
Pulmonary rehabilitation (PR) is an important, evidence-based component for the management of individuals with chronic obstructive pulmonary disease (COPD). In daily practice, the majority of COPD patients are treated in primary care. However, information about the availability of PR in primary care in Sweden is lacking. The aim was to investigate the availability of rehabilitation resources in primary care settings for patients with COPD in Sweden.
A cross-sectional descriptive design was applied, using web-based questionnaires sent to all primary care centres in four regions, comprising more than half of the 9.6 million inhabitants of Sweden. The main questionnaire included questions about the content and availability of rehabilitation resources for COPD patients. PR was defined as exercise training and one or more of the following activities: education, nutritional intervention, energy conservation techniques or psychosocial support.
A total of 381 (55.9%) of the 682 primary care centres answered the main questionnaire. In addition to physicians and nurses, availability of healthcare professionals for rehabilitation in primary care settings was physiotherapists 92.0%, occupational therapists 91.9%, dieticians 83.9% and social workers or psychologists 98.4%. At 23.7% of all centres, PR was not available to COPD patients - neither in primary care nor at hospitals.
Despite high availability of professionals for rehabilitation in primary care settings, about one-quarter of managers at primary care centres stated that their COPD patients had no access to PR. This indicates a need to structure resources for rehabilitation and to present and communicate the available resources within the healthcare system.
肺康复（PR）是慢性阻塞性肺疾病（COPD）患者管理的重要循证组成部分。在日常实践中，大多数COPD患者在基层医疗中接受治疗。然而，瑞典基层医疗中肺康复可及性的信息尚缺。目的是调查瑞典基层医疗环境中COPD患者康复资源的可及性。
采用横断面描述性设计，通过网络问卷向四个地区的所有基层医疗中心发送，这四个地区的居民占瑞典960万总人口的一半以上。主要问卷包括有关COPD患者康复资源的内容和可及性的问题。肺康复被定义为运动训练以及以下一项或多项活动：教育、营养干预、节能技术或心理社会支持。
682个基层医疗中心中共有381个（55.9%）回复了主要问卷。除医生和护士外，基层医疗环境中可提供康复服务的医疗专业人员有物理治疗师（92.0%）、职业治疗师（91.9%）、营养师（83.9%）以及社会工作者或心理学家（98.4%）。在所有中心中，23.7%的中心无法为COPD患者提供肺康复服务——无论是在基层医疗还是在医院。
尽管基层医疗环境中有大量可提供康复服务的专业人员，但约四分之一的基层医疗中心管理人员表示，他们的COPD患者无法获得肺康复服务。这表明需要规划康复资源，并在医疗系统内展示和宣传可用资源。
