农村地区基层慢性病管理人员对慢性阻塞性肺疾病认知的调查研究

Perceptions of Chronic Obstructive Pulmonary Disease among Chronic Disease Managers in Primary Care in Rural Areas

背景 基层慢性病管理人员是慢性阻塞性肺疾病(COPD)防治的“主力军”。了解农村地区基层慢性病管理人员对COPD知识的认知情况,可为今后开展基层COPD防治管理水平提升工作提供科学依据。目的 调查四川省自贡市农村地区基层慢性病管理人员对COPD知识的认知水平,旨在为开展基层COPD防治管理水平提升工作提供科学依据。方法 于2021年6月,采用随机抽样法抽取四川省自贡市20个乡镇卫生院作为样本来源地,整群抽取各乡镇卫生院的所有慢性病管理人员(全科医生、公共卫生人员、乡村医生)作为研究对象,采用自设问卷(包括一般资料调查表、COPD相关知识测试题)对其进行调查,了解慢性病管理人员对COPD知识的认知情况。结果 共发放问卷474份,回收有效问卷474份,有效问卷回收率为100.0%。474例调查对象中,全科医生68例(14.4%),公共卫生人员177例(37.3%),乡村医生229例(48.3%)。全科医生[35.3%(24/68)]和公共卫生人员[31.6%(56/177)]对COPD知识的综合认知及格率高于乡村医生[7.4%(17/229)],差异有统计学意义(P<0.017)。对COPD危险因素知识的认知方面,全科医生[73.5%(50/68)]和公共卫生人员[66.7%(118/177)]的及格率高于乡村医生[46.3%(106/229)],差异有统计学意义(P<0.017)。对COPD诊断与评估知识的认知方面,全科医生[38.2%(26/68)]的及格率高于公共卫生人员[20.3%(36/177)]和乡村医生[3.9%(9/229)],差异有统计学意义(P<0.017);公共卫生人员的及格率高于乡村医生,差异有统计学意义(P<0.017)。对COPD治疗策略知识的认知方面,全科医生[30.9%(21/68)]和公共卫生人员[19.2%(34/177)]的及格率高于乡村医生[6.5%(15/229)],差异有统计学意义(P<0.017)。对COPD随访管理知识的认知方面,公共卫生人员[46.9%(83/177)]的及格率高于全科医生[29.4%(20/68)]和乡村医生[14.4%(33/229)],差异有统计学意义(P<0.017);全科医生的及格率高于乡村医生,差异有统计学意义(P<0.017)。结论 四川省自贡市农村地区基层慢性病管理人员对COPD知识,尤其是COPD诊断与评估、治疗策略、随访管理知识的认知水平较低;不同岗位慢性病管理人员对COPD知识的认知情况不同,乡村医生对COPD知识的认知严重不足。应针对上述问题采取相应措施,进而切实提高农村地区基层COPD防治管理水平。

Background Non-communicable disease(NCD)managers are the main force in the prevention and treatment of chronic obstructive pulmonary disease(COPD). Understanding the perceptions of COPD among NCD managers in primary care in rural areas can provide a scientific basis for enhancing future prevention and management of COPD in primary care.Objective To investigate the perceptions of COPD in NCD managers in rural primary care,offering a scientific basis for the improvement of COPD prevention and management in primary care. Methods In June 2021,random sampling method was used to select 20 township hospitals in Zigong,Sichuan Province,and from which NCD managers[including general practitioners(GPs),public health workers and rural doctors]were selected by use of cluster sampling. A survey was conducted with them using a self-developed questionnaire(consisting of two parts:general demographics and COPD-related knowledge)for understanding their perceptions of COPD. Results All the cases(n=474)who participated in the survey returned responsive questionnaires,achieving a response rate of 100.0%,including 68 GPs(14.4%),177 public health workers(37.3%),and 229 rural doctors(48.3%). With regards to answering the questions of comprehensive COPD knowledge,GPs had statistically significant higher pass rate than rural doctors[35.3%(24/68)vs 7.4%(17/229)](P<0.017),and public health workers also had statistically notably higher pass rate than rural doctors[31.6%(56/177)vs 7.4%(17/229)](P<0.017). In terms of answering the questions about risk factors of COPD,GPs had statistically significant higher pass rate than rural doctors[73.5%(50/68)vs 46.3%(106/229)](P<0.017),and so did public health workers[66.7%(118/177)vs 46.3%(106/229)](P<0.017).In terms of answering the questions about diagnosis and evaluation of COPD,GPs had statistically significant higher pass rate [38.2%(26/68)]than public health workers[20.3%(36/177)]or rural doctors[3.9%(9/229)](P<0.017),and the pass rate of public health workers was statistically significant higher than that of rural doctors(P<0.017). In terms of answering the questions about treatment strategies for COPD,GPs had statistically significant higher pass rate than rural doctors[30.9%(21/68)vs 6.6%(15/229)](P<0.017),and so did public health workers[19.2%(34/177)vs 6.5%(15/229)](P<0.017).In terms of answering the questions regarding follow-up management for COPD,public health workers had statistically significant higher pass rate than GPs[46.9%(83/177)vs 29.4%(20/68)]and rural doctors[46.9%(83/177)vs 14.4%(33/229)](P<0.017).And GPs had statistically significant higher pass rate than rural doctors(P<0.017). Conclusion The NCD managers in primary care in rural areas of Sichuan’s Zigong have insufficient knowledge of COPD,especially its diagnosis,evaluation,treatment strategies and follow-up management. NCD managers from different positions have different perceptions of COPD,among them rural doctors have the lowest level of perception. In view of the above problems,we need to take targeted measures to improve the level of general prevention and management of COPD in rural primary care.