van den Akker Edmée F M M, Van't Hul Alex J, Birnie Erwin, Chavannes Niels H, Rutten-van Mölken Maureen P M H, In't Veen Johannes C C M
a Department of Pulmonary Diseases , STZ Centre of Excellence for Asthma and COPD, Franciscus Gasthuis and Vlietland , Rotterdam , The Netherlands.
b Department of Pulmonary Diseases , Radboud University Medical Centre , Nijmegen , The Netherlands.
COPD. 2017 Apr;14(2):190-199. doi: 10.1080/15412555.2016.1264378. Epub 2016 Dec 27.
A comprehensive diagnostic assessment is needed to improve understanding of the health status of patients with chronic obstructive pulmonary disease (COPD) or asthma. Therefore, this study investigated which components and subsequent instruments should be part of a holistic assessment in secondary care. We also explored which data need to be exchanged for an adequate transfer of patients between primary and secondary care, and vice versa. A cross-sectional Web-based survey was conducted among Dutch healthcare professionals using a Delphi-like procedure; these included professionals working in primary or secondary care, medical advisors of health insurance companies and patients' representatives. The national guidelines were used as a starting point, resulting in a questionnaire addressing 55 components related to a comprehensive diagnostic assessment, covering the domains physiological impairments, symptoms, functional limitations and quality of life. Of the 151 experts and stakeholders invited, 92 (60.9%) completed the first round and 79 (52.3%) the second round; most respondents were pulmonologists. There was a high level of agreement between respondents from primary versus secondary care regarding which components should be measured during a comprehensive assessment of patients with asthma or COPD in secondary care and the instruments to measure these components. Regarding the exchange of information, upon referral, pulmonologists required little information from the general practitioners, whereas general practitioners required more extensive information after referral. An overview is provided of what should be part of a holistic assessment of health status in asthma and COPD. This information can be used as input for integrated care pathways.
需要进行全面的诊断评估，以增进对慢性阻塞性肺疾病（COPD）或哮喘患者健康状况的了解。因此，本研究调查了二级医疗中整体评估应包含哪些组成部分及后续使用的工具。我们还探讨了在初级和二级医疗之间进行患者充分转诊时需要交换哪些数据，反之亦然。采用类似德尔菲法的程序，对荷兰医疗保健专业人员进行了一项基于网络的横断面调查；这些人员包括在初级或二级医疗工作的专业人员、健康保险公司的医学顾问以及患者代表。以国家指南为起点，编制了一份问卷，涉及与全面诊断评估相关的55个组成部分，涵盖生理损伤、症状、功能限制和生活质量等领域。在邀请的151名专家和利益相关者中，92人（60.9%）完成了第一轮调查，79人（52.3%）完成了第二轮调查；大多数受访者是肺科医生。在二级医疗中对哮喘或COPD患者进行全面评估时应测量哪些组成部分以及测量这些组成部分的工具方面，初级医疗与二级医疗的受访者之间达成了高度共识。关于信息交换，转诊时，肺科医生对全科医生的信息需求较少，而全科医生在转诊后需要更广泛的信息。本文提供了哮喘和COPD健康状况整体评估应包含内容的概述。这些信息可作为综合护理路径的输入。
