Miłkowska-Dymanowska Joanna, Białas Adam J, Górski Paweł
Department of Pneumology and Allergy, 1st Chair of Internal Medicine, Medical University of Lodz, 22 Kopcinski avenue, 90-153, Lodz, Poland.
Adv Respir Med. 2017;85(4):179-185. doi: 10.5603/ARM.2017.0030.
Noncompliance with healthcare undoubtedly has a strong influence on the high prevalence of uncontrolled obstructive diseases. The aim of our study was to evaluate the quality of medical conduct in patients with asthma or chronic obstructive lung diseases (COPD), with encompassed two-levelled system of health care.
A survey of general practitioners (GP), allergists and pulmonologists practicing in Poland was performed between September and December 2016. The basic survey included the data concerning the number of treated patients, the course of the visits, treatment regimens and whether the patients follow the instructions of the physician. The specialist survey recorded the details of the specialist visits, their frequency and character, an evaluation of the pharmacological and non-pharmacological therapies and an evaluation of the GP's actions.
The basic questionnaire was completed by 807 doctors with an average of 21 ± 9.85 years of medical experience. Most of the interviewed individuals were GPs (56%), followed by pulmonologists (28%) and allergists (16%). The GP reported 47 cases/month with obstructive pulmonary conditions, including 48.94% asthma and 51.06% COPD patients. They diagnosed three new asthma and COPD patients per month. The allergists treated patients with asthma (105 patients/ month), with 19 newly-diagnosed patients/month. The pulmonologists treated fewer asthma cases than COPD: 71 and 98 patients respectively. They reported 14 patients/month of newly-diagnosed COPD cases. The patients took inhaled glucocorticoids and long-acting b adrenoceptor agonists in separate inhalers. The most frequently-used device was a disc. In opinion of the specialists, half of the therapies initiated recently by GPs for patients with asthma and COPD required modifications.
There is a disparity between the true state of medical care of asthma and COPD patients and globally-accepted standards.
不遵守医疗保健规定无疑对未得到控制的阻塞性疾病的高患病率有很大影响。我们研究的目的是评估哮喘或慢性阻塞性肺疾病（COPD）患者的医疗行为质量，该研究涵盖了两级医疗保健系统。
2016年9月至12月对在波兰执业的全科医生（GP）、过敏症专科医生和肺病专家进行了一项调查。基本调查包括有关接受治疗的患者数量、就诊过程、治疗方案以及患者是否遵循医生指示的数据。专科调查记录了专科就诊的详细信息、就诊频率和特点、对药物和非药物治疗的评估以及对全科医生行为的评估。
807名医生完成了基本问卷，他们的平均医疗经验为21±9.85年。大多数受访个体是全科医生（56%），其次是肺病专家（28%）和过敏症专科医生（16%）。全科医生报告每月有47例阻塞性肺部疾病病例，其中包括48.94%的哮喘患者和51.06%的慢性阻塞性肺疾病患者。他们每月诊断出3例新的哮喘和慢性阻塞性肺疾病患者。过敏症专科医生治疗哮喘患者（每月105例），每月有19例新诊断患者。肺病专家治疗的哮喘病例比慢性阻塞性肺疾病少：分别为71例和98例。他们报告每月有14例新诊断的慢性阻塞性肺疾病病例。患者使用单独的吸入器吸入糖皮质激素和长效β肾上腺素受体激动剂。最常用的装置是碟式吸入器。专家们认为，全科医生最近为哮喘和慢性阻塞性肺疾病患者启动的治疗中，有一半需要调整。
哮喘和慢性阻塞性肺疾病患者的医疗实际状况与全球公认标准之间存在差距。
