上海市市区与郊县基层医生对慢性阻塞性肺疾病的认知现状及培训效果

Awareness of chronic obstructive pulmonary disease-related knowledge in primary-care physicians at urban and suburban Shanghai and effectiveness of training

目的了解上海市基层医生对慢性阻塞性肺疾病（COPD）定义、诊断标准、程度分级以及规范化诊疗等问题的知晓情况。方法采用统一问卷，对上海市12家一级医院（市区4家，郊县8家）和2家二级乙等医院（市区和郊县各1家）的298名医生做COPD相关知识进行问卷调查，并对其中3家医院（市区2家，郊县1家）115名医生进行专业培训。培训后使用同一问卷了解培训效果。结果市区一级医院、市区二级乙等医院、郊县一级医院、郊县二级乙等基层医生对COPD诊断标准的知晓率分别为22．4％（35／156）、25．6％（10／39）、4．3％（3／69）、26．5％（9／34）；抗胆碱能平喘药物知晓率分别为13．5％（21／156）、35．9％（14／39）、0．O％（0／69）、14．7％（5／34）；对COPD程度分级的知晓率仅为0．67％（2／298）。培训后对COPD定义和诊断标准的平均知晓率从18．2％（21／115）提高到72．2％（83／115），对COPD严重程度分级的知晓率从0．8％（1／115）提高到45．2％（52／115）。结论上海市基层医生对COPD缺乏认识，对COPD规范化诊疗不够了解，应加强对基层医生的相关培训及普及肺功能检测项目。

Objective To investigate awareness of definition, diagnostic criteria, severity classification and standard diagnosis and treatment for chronic obstructive pulmonary disease （COPD） among primary-care physicians at the grassroots in urban and suburban Shanghai. Methods In total, 298 physicians were surveyed by unified questionnaire for COPD-related knowledge in two secondary-care general hospitals （one in urban and suburban areas each） and 12 community primary-care centers （four in urban and eight in suburban areas） in Shanghai. One hundred and fifteen physicians in two urban hospitals and one suburban hospital were trained professionally and then evaluated for its effectiveness. Results Awareness of diagnostic criteria of COPD was only 22. 4% （35/156）, 25.6% （ 10/39）, 4. 3 % （3/69） and 26. 5% （9/34） among physicians in urban primary-care hospitals, urban secondary-care hospitals, suburban primary-care hospitals and suburban secondary-care hospitals, respectively. Their awareness of knowledge about use of anti-cholinergic agents was 13.5 % （21/156）, 35.9 % （ 14/39）, naught （0/69）, and 14.7 % （5/34）, respectively. Only 0.67 % of them （ 2/298 ） knew about severity classification of COPD. Awareness of definition and diagnostic criteria for COPD in the physicians increased to 72. 2 % （83/ 115） after training from 18. 2% （21/115） before it, and their awareness of severity classification for COPD increased to 45.2% （52/115） after training from 0. 8 % （1/115） before it. Conclusions Awareness of COPD-related knowledge, especially of standard diagnosis and treatment for COPD, was poor in primary-care physicians at the grassroots in Shanghai, so it is necessary to strengthen training for them in COPD-related knowledge, including pulmonary function tests.