Sarkar Amrita, Javia Abhay, Pithadia Pradeep, Parmar Dipesh
Senior Resident, Department of Community Medicine, NEIGRIHMS, Shillong, Meghalaya, India.
Consultant Pulmonologist, Department of Pulmonology, Sterling Hospital, Rajkot, Gujarat, India.
J Clin Diagn Res. 2017 Jul;11(7):LC04-LC06. doi: 10.7860/JCDR/2017/24883.10251. Epub 2017 Jul 1.
Chronic Obstructive Pulmonary Disease (COPD), a progressive respiratory illness requiring long-term treatment, is a significant cause of morbidity, mortality and economic burden on the family as well as the country. In the tertiary health care facility where the study was carried out, it was observed that many COPD patients did not come for regular follow up. In these patients, treatment interruption may lead to increased morbidity and mortality.
This study aimed to find out the reasons for defaulting follow up and treatment in COPD patients.
All patients of COPD, attending TB Chest outpatient department during the study period (September 2012 to February 2013), were classified into Group A, B, C, and D according to latest Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Data was collected on patient's sociodemographic profile, severity of disease and reasons for defaulting follow up and treatment using pre-tested semi-structured questionnaires, patient history and clinical examination. Data obtained were entered in Microsoft Office Excel 2007 and analysed using Chi-square test.
The mean age of the 200 patients recruited was 59.3 years. A total of 87% patients were male. Patients belonging to Group A, B, C and D were 11%, 25.5%, 41.5% and 22% respectively. Overall, 32% patients were defaulters. Three main reasons for default were non-affordability for treatment expenses (39.07%), resolution of symptoms (26.56%), and too ill to come (18.75%). The associations between default rate and demographic variables like age and gender were found statistically significant.
Default rate among COPD patients is significantly associated with GOLD Group A and D, patient's income and patient literacy level. Main reasons for default were non-affordability of treatment expenses, too ill to come and resolution of symptoms.
慢性阻塞性肺疾病（COPD）是一种需要长期治疗的进行性呼吸系统疾病，是导致发病、死亡以及给家庭和国家造成经济负担的重要原因。在开展本研究的三级医疗保健机构中，观察到许多COPD患者未进行定期随访。在这些患者中，治疗中断可能会导致发病率和死亡率上升。
本研究旨在找出COPD患者未进行随访和治疗的原因。
在研究期间（2012年9月至2013年2月）到结核病胸部门诊就诊的所有COPD患者，根据最新的慢性阻塞性肺疾病全球倡议（GOLD）指南分为A、B、C、D组。使用预先测试的半结构化问卷、患者病史和临床检查收集患者的社会人口统计学资料、疾病严重程度以及未进行随访和治疗的原因。将获得的数据录入Microsoft Office Excel 2007，并使用卡方检验进行分析。
招募的200例患者的平均年龄为59.3岁。共有87%的患者为男性。属于A、B、C、D组的患者分别为11%、25.5%、41.5%和22%。总体而言，32%的患者未按时就诊。未按时就诊的三个主要原因是治疗费用负担不起（39.07%）、症状缓解（26.56%）以及病情太重无法前来（18.75%）。发现未按时就诊率与年龄和性别等人口统计学变量之间的关联具有统计学意义。
COPD患者的未按时就诊率与GOLD A组和D组、患者收入以及患者文化程度显著相关。未按时就诊的主要原因是治疗费用负担不起、病情太重无法前来以及症状缓解。
