患者对 COPD 护理的体验：英国肺脏基金会患者护照的研究结果。
Patient experience of COPD care: outcomes from the British Lung Foundation Patient Passport.
机构信息
National Heart and Lung Institute, Imperial College London, London, UK.
Primary Care Respiratory Society UK, Knowle, UK.
出版信息
BMJ Open Respir Res. 2019 Oct 3;6(1):e000478. doi: 10.1136/bmjresp-2019-000478. eCollection 2019.
INTRODUCTION
The British Lung Foundation (BLF) COPD Patient Passport (www.blf.org.uk/passport) was developed as a resource to help people with chronic obstructive pulmonary disease (COPD) and clinicians to consider the care received and identify essential omissions. We used the online data collected to evaluate the delivery of COPD care in the UK from a patient perspective.
METHODS
The patient passport consists of 13 questions relating to key aspects of COPD care including: spirometry confirmation of diagnosis, understanding their diagnosis, support and a written management plan, vaccinations, smoking cessation, physical activity, exercise, eating well, pulmonary rehabilitation, exacerbations, medications and yearly reviews. Data were presented as proportions with an answer corresponding to good care, and plotted over time to identify trends.
RESULTS
After removing identifiable duplicates, data from 41 769 entries, completed online between November 2014 and April 2019, remained (table 1). Twenty-four per cent reported getting support to manage their care and a written action plan; 53% could spot the signs of an acute exacerbation; 34% had discussed pulmonary rehabilitation and 41% stated they understood their COPD, and their doctor or nurse had explained where to find information, advice and emotional support. A quarter reported not receiving influenza vaccination and a third of those who smoke were not offered support to quit smoking. Even the strongest areas including spirometry-confirmed diagnosis, and knowing the importance of being active and eating well, achieved only around 80%. Response patterns remained stable or worsened over time.
DISCUSSION
Responses to the BLF COPD Patient Passport identify substantial gaps in patients' experience of care, which did not appear to improve during the 5 years covered. These data provide a unique yet commonly overlooked perspective on care quality, and highlight that new approaches will be needed to meet the ambitions to improve respiratory care set out in the NHS Long Term Plan.
简介
英国肺脏基金会（BLF）COPD 患者护照（www.blf.org.uk/passport）旨在帮助慢性阻塞性肺疾病（COPD）患者和临床医生了解所接受的护理，并发现遗漏的关键部分。我们使用在线收集的数据，从患者角度评估英国 COPD 护理的实施情况。
方法
患者护照包含 13 个与 COPD 护理关键方面相关的问题，包括：肺功能检查确认诊断、了解诊断、支持和书面管理计划、疫苗接种、戒烟、体育活动、运动、饮食、肺康复、急性加重、药物治疗和年度复查。数据以比例表示，对应于良好护理的答案，并随时间绘制以识别趋势。
结果
在删除可识别的重复项后，2014 年 11 月至 2019 年 4 月期间，在线完成的 41769 份数据（表 1）仍然有效。24%的患者报告得到了管理护理和书面行动计划的支持；53%的患者能够识别急性加重的迹象；34%的患者讨论过肺康复，41%的患者表示他们了解自己的 COPD，他们的医生或护士解释了在哪里可以找到信息、建议和情感支持。四分之一的患者报告未接种流感疫苗，三分之一的吸烟者未获得戒烟支持。即使是最强的方面，包括肺功能检查确诊诊断以及了解积极运动和健康饮食的重要性，也仅达到 80%左右。随着时间的推移，应答模式保持稳定或恶化。
讨论
对 BLF COPD 患者护照的回应表明，患者对护理的体验存在重大差距，而且在涵盖的 5 年内似乎没有改善。这些数据提供了对护理质量的独特但经常被忽视的视角，并强调需要新的方法来实现国民保健制度长期计划中改善呼吸护理的雄心。
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