专科呼吸科外展服务：在初级保健中发现未确诊 COPD 的病例发现计划。
Specialist respiratory outreach: a case-finding initiative for identifying undiagnosed COPD in primary care.
机构信息
NIHR ARC Wessex, Faculty of Health Sciences, University of Southampton, Southampton, UK.
University Hospital Southampton NHS Foundation Trust, Southampton, UK.
出版信息
NPJ Prim Care Respir Med. 2021 Feb 11;31(1):7. doi: 10.1038/s41533-021-00219-x.
COPD remains largely undiagnosed or is diagnosed late in the course of disease. We report findings of a specialist outreach programme to identify undiagnosed COPD in primary care. An electronic case-finding algorithm identified 1602 at-risk patients from 12 practices who were invited to attend the clinic. Three hundred and eighty-three (23.9%) responded and 288 were enrolled into the study. Forty-eight (16.6%) had undiagnosed mild and 28 (9.7%) had moderate airway obstruction, meeting spirometric diagnostic criteria for COPD. However, at 12 months only 8 suspected COPD patients (10.6%) had received a diagnostic label in their primary care record. This constituted 0.38% of the total patient population, as compared with 0.31% of control practices, p = 0.306. However, if all patients with airway obstruction received a coding of COPD, then the diagnosis rate in the intervention group would have risen by 0.84%. Despite the low take-up and diagnostic yield, this programme suggests that integrated case-finding strategies could improve COPD recognition.
COPD 在很大程度上仍未被诊断或在疾病过程中被诊断较晚。我们报告了一项专家外展计划的结果，该计划旨在在初级保健中发现未被诊断的 COPD。电子病例发现算法从 12 个实践中确定了 1602 名高危患者，邀请他们参加诊所。383 名（23.9%）做出回应，288 名被纳入研究。48 名（16.6%）患有未经诊断的轻度气道阻塞，28 名（9.7%）患有中度气道阻塞，符合 COPD 的肺功能诊断标准。然而，在 12 个月时，只有 8 名疑似 COPD 患者（10.6%）在初级保健记录中获得了诊断标签。这相当于总患者人群的 0.38%，而对照组为 0.31%，p=0.306。然而，如果所有气道阻塞患者都接受 COPD 的编码，那么干预组的诊断率将增加 0.84%。尽管参与率和诊断率较低，但该计划表明，综合病例发现策略可以提高 COPD 的识别率。
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