广州番禺区公立医疗机构部分呼吸科及社区医务人员对慢性阻塞性肺疾病肺康复知识认知的横断面调查

Cross-sectional survey of pulmonary rehabilitation knowledge for medical staff of chronic obstructive pulmonary disease at respiratory departments and community health institutions in Panyu district of Guangzhou

目的了解广州市番禺区公立医疗机构呼吸科及社区医务人员对于慢性阻塞性肺疾病(COPD)管理和肺康复知识的认知水平。方法2017年3至10月,选取番禺区全部公立综合医院以及社区卫生服务中心的339名呼吸专科及社区医务人员进行问卷调查,其中含4个三级医院、5个二级医院、3个一级医院和16个社区卫生服务中心,其中的呼吸科及全科医生(以下统称医生)147名,呼吸科及全科护士(以下统称护士)171名,康复治疗师(以下统称治疗师)22名。用Epidata软件建立问卷库,采用计数资料描述频数分布及百分率。结果护士对于COPD气流受限严重程度分级知晓率只有19.9%,低于医生(39.7%)和治疗师(22.7%)。医生、护士和治疗师熟悉全球慢性阻塞性肺疾病防治倡议指南的比例少,分别只有12.3%、7.6%和4.5%。护士对于肺功能作为COPD确诊依据,其知晓率只有60.2%,低于医生(82.9%)和治疗师(81.8%)。在缓解气促的急救用药中,治疗师选择短效β受体激动剂的比例只有31.8%,低于医生(61.0%)和护士(45.0%)。医生、护士、治疗师对于COPD长期使用吸入激素治疗的意见不一。医务人员对于缩唇呼吸和腹式呼吸认识度最高,其次是太极、八段锦,而对于弹力带、上下肢锻炼等现代康复项目的认知度较低。治疗师对于有效肺康复计划至少应持续8周的知晓率为40.9%,高于医生(13.7%)和护士(18.1%)。医务人员认为,影响患者治疗依从性的主要因素是药费和患者不了解治疗的益处。有40.4%的医生、51.5%护士和54.5%治疗师认为社区卫生服务机构不能管理好COPD。影响社区管理COPD的原因,医生认为是患者依从性差和人力不足,护士认为主要是人力不足和设备不足,治疗师认为是医护认识不足和患者依从性差。结论医生、护士、治疗师对COPD疾病管理及肺康复的认识不一致,各有侧重,必须针对各自薄弱的知识点进行加强学习交流。肺康复的现代康复锻炼不及中医传统康复内容知晓率高,应向患者宣传COPD肺康复治疗的益处和意义,提高患者的依从性。

Objective To understand the cognitive level of chronic obstructive pulmonary disease (COPD) disease management and pulmonary rehabilitation among medical staff in the respiratory departments and community of public health institutions in Panyu of Guangzhou, in order to assess the status of prevention and treatment of COPD in this area. Methods From March to October 2017, a questionnaire survey was conducted among 339 medical staff in Panyu, including respiratory doctors, nurses and therapists of four tertiary hospitals, five secondary hospitals, and three first-level hospitals, GPs, nurses and therapists at 16 community health service centres, among them, there are 147 respiratory and general practitioners (hereinafter referred to as doctors), 171 respiratory and general nurses (hereinafter collectively referred to as nurses), and 22 rehabilitation therapists (hereinafter collectively referred to as therapists). Using Epidata software to create questionnaire database entry data. Results The awareness rate of COPD airflow limitation severity of nurses was only 19.9%, which was lower than that of doctors (39.7%) and therapists (22.7%). Doctors, nurses, and therapists are familiar with the low percentage of the GOLD guidelines, which are respectively only 12.3%, 7.6%, and 4.5%. Nurses were diagnosed with pulmonary function as a basis for COPD, and the awareness rate was only 60.2% lower than that of doctors (82.9%) and therapists (81.8%). In alleviating COPD patients' shortness of breath, only 31.8% therapists chose short-acting beta-agonists, lower than doctors (61%) and nurses (45%). There is disagreement about the Iong-term use of inhaled corticosteroids in COPD. Medical staff have the highest awareness of lip-reducing and abdominal breathing, followed by Taiji and Ba Duan Jin exercises, and low awareness of modern rehabilitation programs such as elastic bands, upper and lower limb exercises. The effective pulmonary rehabilitation program should last at least 8 weeks, and the awareness rate of this therapy practice was 40.9%, higher than doctors (13.7%) and nurses (18.1%). Medical staff believe that the main factors affecting patient compliance are the cost of the drug and the patient's lack of understanding of the benefits of the treatment. Additionally, 40.4% of doctors, 51.5% of nurses, and 54.5% of therapists believe that community health services can not manage COPD. The reasons that affect community management of COPD, doctors believe that patient compliance and lack of man power;nurses believe that the main shortage of manpower and equipment, the therapist believes that the lack of medical awareness and poor patient compliance. Conclusion Doctors, nurses, and therapists have inconsistent understandings of COPD disease management and pulmonary rehabilitation, and each has its own focus. It is necessary to strengthen learning exchanges for each weak knowledge point. The awareness rate of modern rehabilitation exercise for pulmonary rehabilitation is not as high as that of traditional Chinese medicine. It is necessary to pay attention to the promotion of the benefits and significance of COPD pulmonary rehabilitation treatment and improve compliance.