Solanes Ingrid, Bolíbar Ignasi, Llauger Maria Antònia, Peiro Meritxell, Valverde Pepi, Fraga Mar, Medrano Casimira, Bigorra Teresa, Freixas Montserrat, Ligüerre Iskra, Pou Maria Antònia, Domínguez Leandra, Valero Carles, Solà Judit, Giner Jordi, Plaza Vicente
Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Institut de recerca biomèdica (IIB Sant Pau), Universidad Autónoma de Barcelona, Barcelona, España.
Servicio de Epidemiologia Clínica y Salud Pública, Hospital de la Santa Creu i Sant Pau, Institut de recerca biomèdica (IIB Sant Pau), Universidad Autónoma de Barcelona, Ciber de Epidemiología y Salud Pública (CIBERESP), Barcelona, España.
Aten Primaria. 2018 Mar;50(3):184-196. doi: 10.1016/j.aprim.2017.01.014. Epub 2017 Jul 21.
To evaluate the effectiveness of two management programs on patients with chronic obstructive pulmonary disease (COPD).
A study with a quasi-experimental design was used to evaluate the effectiveness of two interventions (I1, I2) for the care of patients with COPD after a mean follow-up of 31.2months.
Primary Care Centres in two Barcelona Health Areas and their referral hospitals.
Patients with COPD selected by simple random sampling using any disease code corresponding to COPD.
I1: Integrated management program that was optimised and coordinated the resources. Training was given, as well as quality control of spirometry. I2: Isolated interventions like a call-centre. Care circuits and computerised clinical notes were shared.
Variables were recorded as regards lung function, severity, use of inhalers, lifestyles, quality of life, and exacerbations.
Of the 393 patients evaluated at the beginning, 120 and 104 (I1 and I2, respectively) received the final evaluation. With I1, there was a reduction in patients who smoked (P=.034). Lung function and quality of life did not change significantly in either group, but shortness of breath was slightly worse. There was an increase in the correct use of inhalers, although it only reached 48% and 61% with interventions I1 and I2, respectively. The percentage of patients with exacerbations decreased with I1 compared to that of I2 (P<.001), and there were less hospital admissions due to exacerbations with I2 compared to I1 (P<.003]).
Both interventions achieved significant improvements, and no overall worsening of a chronic and progressive disease as is COPD.
评估两种管理方案对慢性阻塞性肺疾病（COPD）患者的有效性。
采用准实验设计研究，对两种干预措施（I1、I2）在平均随访31.2个月后对COPD患者护理的有效性进行评估。
巴塞罗那两个健康区域的初级保健中心及其转诊医院。
使用与COPD对应的任何疾病代码通过简单随机抽样选择的COPD患者。
I1：优化并协调资源的综合管理方案。提供培训，并对肺活量测定进行质量控制。I2：如呼叫中心等单独的干预措施。共享护理流程和计算机化临床记录。
记录有关肺功能、严重程度、吸入器使用情况、生活方式、生活质量和病情加重情况的变量。
在最初评估的393例患者中，分别有120例和104例（分别为I1和I2组）接受了最终评估。对于I1组，吸烟患者有所减少（P = 0.034）。两组的肺功能和生活质量均无显著变化，但呼吸急促情况略有恶化。吸入器的正确使用有所增加，尽管I1和I2干预措施下分别仅达到48%和61%。与I2组相比，I1组病情加重的患者百分比有所下降（P < 0.001），与I1组相比，I2组因病情加重导致的住院次数较少（P < 0.003）。
两种干预措施均取得了显著改善，且并未使像COPD这样的慢性进行性疾病整体恶化。
