慢性阻塞性肺疾病规范化诊治宣教在社区老年住院患者中的应用研究

Application of Standardized Diagnosis and Treatment Education of COPD in Hospitalized Elderly in Community Health Service Center

目的了解金山区社区卫生服务中心住院慢性阻塞性肺疾病(COPD)患者的诊治现状,探讨COPD规范化诊治宣教对社区卫生服务中心COPD患者诊断及治疗效果的临床价值。方法以金山区某社区医院2016年10月1日—2017年3月31日住院并诊断为COPD和慢性支气管炎的238例老年患者为研究对象,随机分为观察组及对照组,2组分别进行规范化宣教和常规宣教后,观察3个月及6个月,了解2组患者的CAT评分、戒烟率、专科就诊率、COPD确诊率、规范化治疗率、延伸处方率、急性加重次数及肺功能的改善比率。结果 2组3个月及6个月戒烟率无明显差异(P>0.05);2组3个月及6个月CAT评分相比较观察组均高于对照组,且差异有统计学意义P<0.05);观察组3个月COPD确诊率高于对照组,差异有统计学意义(P<0.05),6个月时观察组更加优于对照组(P<0.01);2组3个月及6个月专科就诊率、规范化治疗率、延伸处方率、肺功能改善者比率相比较观察组均高于对照组,差异有统计学意义(值均<0.01);3个月及6个月期间急性加重次数观察组均低于对照组,差异有统计学意义(P<0.01)。结论金山区社区卫生服务中心COPD患者的规范化诊治水平普遍较低,通过COPD规范化诊治宣教可促使COPD患者在基层社区卫生服务中心得到规范诊断和治疗。

Objective To investigate the current situation of diagnosis and treatment of the elderly with chronic obstructive pulmonary disease（COPD） in community health service centers of Jinshan District, Shanghai and to explore the clinical application value of the education. Methods 238 hospitalized elderly with the diagnosed of chronic bronchitis and COPD in a community hospital in Jinshan District during the period from October 1, 2016 to March 31, 2017 were selected and randomly divided into 2 groups： observation group（standardized education） and control group（conventional education）; observation was made to the elderly in the 2 groups, lasting from 3 months to 6 onths; the CAT scores, smoking-quitting rate, special clinic rate, confirmed diagnosis of COPD, standardized treatment rate, extended prescription rate, the times of acute aggravation and the improvement ratio of pulmonary function in the 2 groups were investigated at the time point of 3 months and 6 months after education respectively. Results There existed no obvious difference in smoking-quitting rate between the 2 groups at the time point of 3 and 6 months（ P0.05）; the CAT scores at the time point of 3 months and 6 months after education in observation group was higher than those in control group, and the difference was of statistical significance（ P0.05）; COPD confirmed diagnosis at the time point of 3 months in observation group was higher than that in control group（ P0.05） and that at the time point of 6 months in observation group was even more superior to that in control group（ P0.01）; the special clinic rate, standardized treatment rate, extended prescription rate, pulmonary function improvement ratio at the time point of 3 and 6 months respectively in observation group were higher than those in control group（P 0.01）; the times acute aggravation at the time point of 3 months and 6 months in observation group were less than those incontrol group（ P0.01）. Conclusions The level of standardized diagnosis and treatment of COPD in community health service centers in Jinshan District is generally low; with the application of standardized diagnosis and treatment education of COPD, the elderly can receive standardized diagosis and treatment in the basic community health service centers.