Soler-Cataluña J J, Fernández Villar A, Piñera Salmerón P L, Román-Rodríguez M, Huerta Hernández A, Roset Gamisans M
Servicio de Neumología, Hospital de Arnau de Vilanova-Lliria, Valencia, España.
Servicio de Neumología, Hospital Álvaro Cunqueiro, Instituto de Investigación Biomédica Galicia Sur, Vigo, Pontevedra, España.
Semergen. 2018 Oct;44(7):449-457. doi: 10.1016/j.semerg.2018.03.010. Epub 2018 Sep 8.
Chronic obstructive pulmonary disease exacerbations (COPDE) lead to a high use of healthcare resources. This study assesses the healthcare and organisational resources of Spanish health care centres for the management of COPDE at different care levels (Primary Care (PC), Respiratory Diseases, Internal Medicine, and Emergency Departments), and compare with current recommendations.
An observational study was carried out through telephone interviews to General Practitioners, Chest Diseases, Internal Medicine, and Emergency Department doctors.
A total of 284 doctors were interviewed. According to their responses, at PC centres there is a high availability of pulse oximetry (98.9%) and electrocardiograph (100%), and a low availability of Chest X-Ray (19.1%), or urgent laboratory tests (17.0%) in sites. In hospital wards, non-invasive mechanical ventilation (NIV) availability was 76.1%, with only a 69.7% of nursing staff properly trained in its use. Respiratory intermediate care units (RICUs) were available in 18.3% of public hospitals versus 41.7% of private hospitals. Specific training for COPDE management was received by 47.9% of Emergency Department doctors in the previous year. Only 31.9% of PC centres had specific protocols for referring patients to specialists. More than 35% of PC centres and hospitals do not have their electronic medical records integrated with other healthcare levels.
In general terms, there are sufficient resources available in Spanish healthcare centres. However, several areas of improvement were identified, such as an insufficient level of electronic medical record integration between healthcare levels, limited implementation of RICUs in public hospitals, and deficiencies related to specific training in NIV management.
慢性阻塞性肺疾病急性加重（COPDE）导致医疗资源的大量使用。本研究评估了西班牙医疗中心在不同护理级别（初级护理（PC）、呼吸系统疾病、内科和急诊科）管理COPDE的医疗和组织资源，并与当前建议进行比较。
通过电话采访全科医生、胸科疾病医生、内科医生和急诊科医生进行了一项观察性研究。
共采访了284名医生。根据他们的回答，在PC中心，脉搏血氧饱和度仪（98.9%）和心电图仪（100%）的可用性较高，而胸部X光（19.1%）或紧急实验室检查（17.0%）的可用性较低。在医院病房，无创机械通气（NIV）的可用性为76.1%，只有69.7%的护理人员接受过正确使用NIV的培训。18.3%的公立医院设有呼吸中间护理单元（RICUs），而私立医院的这一比例为41.7%。去年，47.9%的急诊科医生接受了COPDE管理的专项培训。只有31.9%的PC中心有将患者转诊给专科医生的具体方案。超过35%的PC中心和医院没有将其电子病历与其他医疗级别整合。
总体而言，西班牙医疗中心有足够的资源。然而，也发现了几个需要改进的领域，如医疗级别之间电子病历整合水平不足、公立医院RICUs实施有限以及NIV管理专项培训存在缺陷。
