理论与实践结合培训对基层医师慢性阻塞性肺疾病认知的影响  

Practice-oriented training improves knowledge levels of chronic obstructive pulmonary disease among primary care physicians

作　　者：郝兴亮[1] 丁菊英[2] 王莹莹[2] 纪艳荣[1] 张建[1] 王晓坤[2] 李霜[1] 刘伟 Hao Xingliang;Ding Juying;Wang Yingying;Ji Yanrong;Zhang Jian;Wang Xiaokun;Li Shuang;Liu Wei(Department of Respiratory and Critical Care Medicine,Shengli Oilfield Central Hospital,Dongying 257034,China;Clinical Pharmacy Unity,Department of Pharmacy,Shengli Oilfield Central Hospital,Dongying 257034,China)

机构地区：[1]胜利油田中心医院呼吸与危重症医学科,东营257034 [2]胜利油田中心医院药学部临床药学,东营257034

出　　处：《中华全科医师杂志》2022年第5期477-481,共5页Chinese Journal of General Practitioners

基　　金：山东省医药卫生科技发展计划项目(202013010179)。

摘　　要：为研究理论与实践结合培训对提高基层医师慢性阻塞性肺疾病(慢阻肺)认知水平的影响,2020年12月7—25日,在本地区全部34家一级医疗机构(乡镇卫生院及社区卫生服务中心)中,应用随机数字表法在每家机构中随机抽取1名内科或全科医师进行慢阻肺培训,共34人,采用理论授课与临床实践相结合的方式进行。根据慢阻肺诊疗指南设计调查问卷,内容包括慢阻肺临床特征、肺功能、吸入技术的认知,比较分析培训前后基层医师慢阻肺认知情况。结果显示,基层医师对慢阻肺的定义及高危因素的认知率低,67.6%(23/34)的医师对慢阻肺相关指南及新进展不了解,17.6%(6/34)医师表示在临床工作中进行慢阻肺随访评估、肺康复、健康宣教,仅有8.8%(3/34)的医师曾应用改良版英国医学研究委员会(mMRC)呼吸困难问卷和慢阻肺患者自我评估测试(CAT)评估病情;参与培训的基层医师所在单位均无肺功能仪,仅有3名医师(8.8%)既往参加过肺功能的培训,能掌握肺功能检查适应证、禁忌证及完成报告解读。所有基层医师均不能完全正确使用常见吸入装置及掌握吸入技术,11.8%(4/34)的医师评估过患者吸入技术及吸入装置完成情况,培训后,基层医师慢阻肺的临床特征、肺功能及吸入技术的认知得到明显提高,各项评分较培训前有显著改善,差异有统计学意义(均P<0.001)。提示基层医师对慢阻肺临床知识与技能认识不足,理论与实践相结合的专题培训可提高基层医师的慢阻肺诊疗和管理能力。A 3-week practice-oriented training course on chronic obstructive pulmonary disease(COPD)management was conducted in December 2020,34 primary care physicians from township or community health service centers attended the course.The impact of the training course on the knowledge levels of COPD management was evaluated with a questionnaire survey,the questionnaire contained the knowledge of COPD and its management.The survey showed that before the training,the participants had low knowledge levels on the definition of COPD and its risk factors;67.6%(23/34)were not aware of COPD-related guidelines and new developments,and 17.6%(6/34)had conducted COPD follow-up assessments,pulmonary rehabilitation,and health education;only 8.8%(3/34)had used the improved British Medical Research Council Dyspnea Index(mMRC)and the chronic obstructive pulmonary disease assessment test(CAT)for patient self-assessment;there was no pulmonary function instrument in their units,and only 3 doctors(8.8%)had previously participated in pulmonary function training and knew indications and contraindications of the pulmonary function test,and complete report interpretation;all participants were unable to use common inhalation devices and master inhalation techniques completely and correctly;11.8%(4/34)had assessed patients′handling inhalation devices and performing inhalation.After the training,the knowledge levels of COPD clinical features,lung function and inhalation technique were significantly improved,and the scores were significantly increased compared with those before the training(P<0.001).The study shows that primary care physicians have insufficient knowledge and management skill of COPD.The practice-oriented training can significantly improve the knowledge and skills of primary care physician for COPD management in the community.

关 键 词：肺疾病 慢性阻塞性 基层医师 问卷调查 认知 

分 类 号：R-4[医药卫生] C975[经济管理—劳动经济]