Gupta Ashish V, Phatak Ajay G, Patel Meha U, Das Neha, Vaghela Nirav P, Prakash Harihara, Raithatha Shyamsudar J
K M Patel Institute of Physiotherapy, Karamsad, Anand, Gujarat, India.
Central Research Services, Pramukhswami Medical College, Karamsad, Anand, Gujarat, India.
J Family Med Prim Care. 2020 Apr 30;9(4):1910-1914. doi: 10.4103/jfmpc.jfmpc_1193_19. eCollection 2020 Apr.
Chronic obstructive pulmonary disease (COPD) is the second leading contributor to the disease burden of India. The current COPD burden cannot be managed effectively just through a physician-based approach. In a primary care setting, community health workers (CHWs) can play an effective role in making COPD care accessible and effective.
Findings of an assessment of a training program for CHWs on COPD have been reported here. Methods: 90 CHWs working as a part of a noncommunicable disease prevention and care program in a rural primary care setting were exposed to a series of five training sessions. The sessions were designed and administered jointly by a team of public health experts and physiotherapists in the year 2017-18. Topics covered were basic clinical aspects of COPD, monitoring a patient with COPD, and basic aspects of pulmonary rehabilitation. The assessment comprised 12 MCQs and short questions, 7 video exercises, 2 case vignettes, and 5 skill assessments through objectively structured clinical examination (OSCE).
Mean percentage scores were calculated for each domain of assessment to make it comparable.
70 CHWs with a mean age of 42.2 years completed all the training and underwent the assessment. Mean percentage score (SD) for knowledge was 62% (16.3). In OSCE assessment, scores were best in sputum clearance technique demonstration (92.1%) and the least in dyspnea relieving positions (59.2%). The CHWs had difficulties in identifying signs of respiratory distress (score - 55.1%). No statistically significant association was observed between performance scores and their sociodemographic profile.
The results were encouraging and the program may be pilot tested in a government setting particularly using the health and wellness centers (HWC) platform.
慢性阻塞性肺疾病（COPD）是印度疾病负担的第二大主要成因。仅通过基于医生的方法无法有效管理当前的COPD负担。在初级保健环境中，社区卫生工作者（CHW）可以在使COPD护理可及且有效方面发挥有效作用。
本文报告了一项针对社区卫生工作者的COPD培训项目的评估结果。方法：作为农村初级保健环境中一项非传染性疾病预防和护理项目一部分的90名社区卫生工作者参加了一系列五场培训课程。这些课程由一组公共卫生专家和物理治疗师在2017 - 18年共同设计和实施。涵盖的主题包括COPD的基本临床方面、COPD患者的监测以及肺康复的基本方面。评估包括12道多项选择题和简答题、7个视频练习、2个病例 vignettes以及通过客观结构化临床检查（OSCE）进行的5项技能评估。
计算每个评估领域的平均百分比得分以使其具有可比性。
70名平均年龄为42.2岁的社区卫生工作者完成了所有培训并接受了评估。知识方面的平均百分比得分（标准差）为62%（16.3）。在OSCE评估中，痰液清除技术演示得分最高（92.1%），缓解呼吸困难姿势得分最低（59.2%）。社区卫生工作者在识别呼吸窘迫体征方面存在困难（得分 - 55.1%）。在表现得分与其社会人口统计学特征之间未观察到统计学上的显著关联。
结果令人鼓舞，该项目可在政府环境中进行试点测试，特别是利用健康与 wellness 中心（HWC）平台。
