目的:初级保健医师(PCPs)主要负责COPD患者的初始诊断和门诊护理。本调查的目的是根据当前指南调查德国COPD的初始管理,并确定任何偏差。
方法:进行了一项前瞻性横断面调查,作为一项多项选择问卷,向德国七个联邦州(每个州有一个大城市和周边国家)的1836个PCP发送。产品中性问题集中在当前国家和国际(GLOBAL)COPD指南的关键方面。
结果:486名医生参与了研究(有效率26.5%)。66.5%的医生使用德国COPD指南,20.8%使用黄金指南,只有11.7%的人没有遵守指导方针。医生意识到COPD的流行病学和公共卫生意义。76.5%的人将肺活量测定法视为诊断标准:在90.1%的实践中可用。然而,只有60-65%的人能够引用正确的肺活量测定标准来分类疾病的严重程度.帮助患者戒烟的教育措施以及患者吸入技术的教学和监测未得到充分实施。引用的两个最重要的治疗目标是改善生活质量(69.1%)和预防恶化(53.1%)。除了使用类固醇的标准和实施肺康复措施外,基于严重程度分类的COPD治疗在很大程度上符合指南.然而,相当比例的医师错误地评估了各种治疗措施的循证临床获益.
结论:研究表明,尽管人们高度重视COPD指南,在COPD的诊断和治疗以及教育措施的实际实施方面存在不足。
OBJECTIVE: Primary care physicians (PCPs) are the ones mainly responsible for the initial diagnosis and outpatient care of patients with COPD. The aim of the present survey was to investigate their initial management of COPD in Germany based on current
guidelines and to identify any deviations.
METHODS: A prospective cross-sectional survey was conducted as a multiple-choice questionnaire sent out to 1836 PCPs in seven Federal States of Germany (one large town and surrounding country in each). The product-neutral questions focused on the key aspects of current national and international (GLOBAL) COPD
guidelines.
RESULTS: 486 physicians participated in the study (response rate 26.5%). 66.5% of the physicians used the German COPD
guidelines, 20.8% used GOLD
guidelines, and only 11.7% observed no
guidelines. The physicians were aware of the epidemiological and public health significance of COPD. 76.5% saw spirometry as the diagnostic standard: it was available in 90.1% of the practices. However, only 60-65% were able to cite the correct spirometric criteria for classifying severity of the disease. Educational measures to help patients quit smoking and the teaching and monitoring of patients\' inhalation technique were inadequately implemented. The two most important therapeutic goals cited were to improve quality of life (69.1%) and prevent exacerbations (53.1%). Except for the criteria for the use of steroids and the implementation of pulmonary rehabilitation measures, treatment of COPD based on severity class was largely in compliance with the guidelines. However, a significant percentage of the physicians incorrectly assessed the evidence-based clinical benefits of various therapeutic measures.
CONCLUSIONS: The study shows that, despite the high regard in which COPD
guidelines are held, deficiencies exist with regard to the diagnosis and treatment of COPD and the practical implementation of educational measures.