Villar-Álvarez Felipe, Moreno-Zabaleta Raúl, Mira-Solves Jose Joaquin, Calvo-Corbella Eduardo, Díaz-Lobato Salvador, González-Torralba Fernando, Hernando-Sanz Ascensión, Núñez-Palomo Sara, Salgado-Aranda Sergio, Simón-Rodríguez Beatriz, Vaquero-Lozano Paz, Navarro-Soler Isabel María
Department of Pulmonology, IIS-Fundación Jiménez Díaz, CIBERES, UAM.
Pulmonology, Inpatient and Noninvasive Mechanical Ventilation, Hospital Universitario Infanta Sofía, Madrid.
Int J Chron Obstruct Pulmon Dis. 2018 Feb 2;13:451-463. doi: 10.2147/COPD.S151939. eCollection 2018.
To identify practices that do not add value, cause harm, or subject patients with chronic obstructive pulmonary disease (COPD) to a level of risk that outweighs possible benefits (overuse).
A qualitative approach was applied. First, a multidisciplinary group of healthcare professionals used the Metaplan technique to draft and rank a list of overused procedures as well as self-care practices in patients with stable and exacerbated COPD. Second, in successive consensus-building rounds, description files were created for each "do not do" (DND) recommendation, consisting of a definition, description, quality of supporting evidence for the recommendation, and the indicator used to measure the degree of overuse. The consensus group comprised 6 pulmonologists, 2 general practitioners, 1 nurse, and 1 physiotherapist.
In total, 16 DND recommendations were made for patients with COPD: 6 for stable COPD, 6 for exacerbated COPD, and 4 concerning self-care.
Overuse poses a risk for patients and jeopardizes care quality. These 16 DND recommendations for COPD will lower care risks and improve disease management, facilitate communication between physicians and patients, and bolster patient ability to provide self-care.
识别那些没有增加价值、造成伤害或使慢性阻塞性肺疾病（COPD）患者面临的风险超过可能益处（过度使用）的医疗行为。
采用定性研究方法。首先，一个多学科医疗专业人员小组使用Metaplan技术起草并对稳定期和加重期COPD患者过度使用的医疗程序以及自我护理行为清单进行排序。其次，在连续的共识建立轮次中，为每个“不做”（DND）建议创建描述文件，包括定义、描述、该建议支持证据的质量以及用于衡量过度使用程度的指标。共识小组由6名肺科医生、2名全科医生、1名护士和1名物理治疗师组成。
总共为COPD患者提出了16条DND建议：稳定期COPD患者6条，加重期COPD患者6条，自我护理相关4条。
过度使用给患者带来风险并危及护理质量。这16条针对COPD的DND建议将降低护理风险并改善疾病管理，促进医患沟通，增强患者自我护理能力。
