Mid-term Follow-up Of Management And Intervention On Chronic Obstructive Pulmonary Disease In Hunan Province

PART1Mid-term Follow-up of Mangment and Treatment of COPD among Different Level Hospitals in Hunan ProvinceObjective:To investigate the change of medical resources associated with the management of chronic obstructive pulmonary disease (COPD) in recent4years among different level hospitals in Hunan province.Methods:48hospitals (153rd level hospitals,242nd level hospitals,91st level hospitals) which participated in the survey in early stage (in2009) were selected. Questionnaires of COPD knowledge were self-designed. Physicians involved in diagnosis and treatment of respiratory disease were organized to complete the questionnaire. By using statistical software SPSS17.0and CS14.0, we analyzed the data to explore the changes of COPD related equipment, pharmaceuticals, health education for patients atientsin4years. The doctors’ questionnaires were analyzed based on the level of hospitals, doctors’ educational background, job title, sources of ccontinuing medical education.Results:(1) The universal equipment of spirometer in all hospitals was68.75%in2013(100.00%in3rd level hospitals,75.00%in2nd level hospitals,0.00%in1st level hospitals), which was increased than that in2009.(2) The total usage of inhalation in all hospitals was93.75%in2013(100.00%in3rd level and2nd level hospitals,33.33%in1st level hospitals), increased than in2009.(3) The universal rate of COPD health education was62.50%(86.67%in3rd level hospitals,62.50%in2nd level hospitals,22.22%in1st level hospitals). No statistical significance was detected between that in2013and in2009among each group of hospitals.(4) In3rd level hospitals,204physicians participated in the COPD knowledge questionnaire, with a pass rate of100%and a median score of90. Among the506physicians from2nd level hospitals, the pass rate was64.62%, and the median score was60. Among the52physicians from1st level hospitals, the pass rate was17.31%, and the median score was40. There was significant difference between physicians’ score and pass rate in different levels of hospitals (P<0.05). The physicians’ score and pass rate in2013was decreased compared with those in2009(P<0.001), which was particularly prominent in the group of2nd level hospitals.(5) Among physicians from3rd level hospitals, the correct rate of topic1st to topic10th was85.78%、97.06%、91.18%、100.00%、82.84%、91.18%、80.88%、90.20%、97.55%、83.33%,respectively, among physicians from2nd level hospitals, the correct rate was54.94%、83.00%、47.63%、47.04%、43.28%、64.82%、50.79%、66.21%、92.69%、55.53%、 respectively, and among physicians from1st level hospitals, the correct rate was40.38%6、5.38%、21.15%、40.38%、23.08%、26.92%、30.77%、28.85%、78.85%、40.38%、 respectively.(6) Among physicians from3rd level hospitals,45.59%were high-educated,54.41%were middle-educated. Among physicians from2nd level hospitals,3.16%were high-educated,75.10%were middle-educated,21.74%were low-educated. Among physicians from1st level hospitals,55.77%were middle-educated,44.23%were low-educated. There was significant difference in the educational background among physicians from different levels of hospitals (P<0.05).(7) Among109high-educated physicians, the pass rate was99.08%, and the median score was100. Among520middle-educated physicians, the pass rate was76.35%, and the median score was70. Among133low-educated physicians, the pass rate was26.32%, and the median score was40. There was significant difference in pass rate and median score among physicians with different educational background (P<0.05).(8) Among124physicians with senior titles, the pass rate was100%, and the median score was90. Among332physicians with intermediate titles, the pass rate was76.50%, and the median score was70. Among306physicians with junior titles, the pass rate was52.94%, and the median score was60. There was significant difference in pass rate and median score among physicians with different titles (P<0.05).(9) When asked about the main way of COPD-associated continuing medical education,227physicians chose seminar or class(with a pass rate of95.59%and median score of90),148physicians chose advanced studies(with a pass rate of97.97%and median score of80),128physicians chose reading the relevant literature(with a pass rate of61.72%and median score of60),148physicians chose internet-based learning(with a pass rate of57.82%and median score of60),111physicians chose other ways (with a pass rate of12.61%and median score of30).(10) Bivariate Correlation (Spearman) showed that score was correlated with the hospital level, enducationnal background, professional titles (P<0.0001),but not correlated with age (P=0.559)Conclusions:(1) In2013, the universal equipment of spirometer and usage of inhaled agents was increased than that in2009.(2) No improvement on COPD health education for the patient was discovered in2013compared with in2009.(3) Physician’s understanding of COPD was associated with hospital level, educational background, job title and the way of COPD-associated continuing medical education. PART2Mid-term Follow-up of COPD Diagnosis and Treatment Intervened by Short-term Education and Spirometry EquipmentObjective:To observe the medium-term effect of short-term education and spirometry equipment on COPD diagnose among the2nd level hospitals.Methods:62nd level hospitals which participated in the survey in early stage(in2009)were selected and divided into intervention group and control group. Physicians who directly involved in diagnosis and management of respiratory disease were organized to complete the COPD knowledge questionnaire. In a same period of3months before intervention, during intervention and follow-up visit, clinical doubtful diagnostic ratio and confirmation ratio of COPD in both groups was compared, and implementation of lung function test was observed. Statistical software SPSS17.0and CS14.0were used to analyze the difference between the two groups.Results:(1) Among physicians of intervention group, the median score of COPD knowledge questionnaire was80, and the pass rate was89.74%, which were higher than those of the control group (50and46.3%respectively, P<0.05).(2) In hospitals of intervention group, the clinical doubtful diagnostic ratio and confirmation ratio of COPD during intervention and follow-up visit was higher than that of the control group(P<0.001).(3) In hospitals of intervention group, the implementation of lung function test was higher than in control group(P <0.05).Conclusions:(1) Short-term training combined with spirometry equipment could effectively improve the level of physician’s understanding of COPD, and has a satisfying medium-term effect。(2) Short-term training combined with spirometry equipment could effectively improve the level of COPD diagnose in2nd level hospitals。...