上海市社区慢性阻塞性肺疾病诊疗质量及管理能力状况调查  

Survey on the quality of medical care and management for chronic obstructive pulmonary disease in Shanghai community health service centers

作　　者：郭爱珍 金花 陈晨 何柳华 于德华 Guo Aizhen;Jin Hua;Chen Chen;He Liuhua;Yu Dehua(Department of General Practice,Yangpu Hospital,School of Medicine,Tongji University,Shanghai General Practice Clinical Quality Control Center,Shanghai General Practice and Community Health Development Research Center,Shanghai 200090,China;Jiangning Subdistrict Community Health Center of Jing′an District,Shanghai 200041,China;Shcool of Medicine,Tongji University,Shanghai 200090,China)

机构地区：[1]同济大学附属杨浦医院全科医学科,上海市全科医学临床质量控制中心,上海市全科医学与社区卫生发展研究中心,上海200090 [2]上海市静安区江宁路街道社区卫生服务中心,上海200041 [3]同济大学医学院,上海200090

出　　处：《中华全科医师杂志》2024年第10期1011-1020,共10页Chinese Journal of General Practitioners

基　　金：杨浦区科学技术委员会杨浦区卫生健康委员会科研项目(YPYG202302);同济大学附属杨浦医院学科带头人攀登计划(Ye2202302)。

摘　　要：目的从社区卫生服务中心和社区医生两个维度调查上海市社区慢性阻塞性肺疾病(慢阻肺)的诊疗质量及管理能力。方法该研究为横断面研究。2023年10-11月,采用自制问卷对上海市全部248家社区卫生服务中心慢阻肺诊疗设备、药品、技术支持、信息互通、管理内容等进行调查,并对城区与郊区社区卫生服务中心相关数据进行比较;同时通过随机整群抽样的方法,抽取各行政区50%的社区卫生服务中心,再按技术职称进行分层抽取50%医生进行问卷调查,内容包括慢阻肺早期筛查、诊断和治疗、稳定期管理相关知识的掌握情况及培训需求等。结果(1)社区卫生服务中心调查结果:机构问卷共调查248家社区卫生服务中心。社区卫生服务中心慢阻肺诊疗设备获得率从高到低前3位依次是脉搏氧饱和度检测仪(97.6%,242/248)、X线摄片仪(96.8%,240/248)、雾化器(96.0%,238/248),其中城区社区卫生服务中心6 min步行试验系统、无创呼吸机和康复训练仪的获得率高于郊区(P<0.05),郊区社区卫生服务中心计算机断层扫描仪(CT)获得率高于城区(P<0.05)。慢阻肺治疗基本药品获得率从高到低前3位依次为茶碱类药物(91.5%,227/248)、口服糖皮质激素(85.9%,213/248)、静脉用糖皮质激素(81.0%,201/248),郊区社区卫生服务中心口服和静脉用糖皮质激素的可获得率均高于郊区(P<0.05)。慢阻肺诊疗技术开展率从高到低前3位依次为肺功能检查(95.6%,213/248)、脉搏氧饱和度检测(93.5%,232/248)、无创呼吸治疗(53.2%,132/248),城区社区卫生服务中心肺功能检查、血气分析、无创呼吸机治疗及康复的开展率均高于郊区(P<0.05)。慢阻肺慢病管理中开展较多的工作前3位依次是早期筛查(85.1%,211/248)、健康档案的建立(66.5%,165/248)和转诊通道(62.9%,156/248),城区社区卫生服务中心呼吸专病门诊和转诊通道的设立比例高于郊区(P<0.05)。(2)社区医Objective To survey the quality of medical care and management for chronic obstructive pulmonary disease(COPD)in Shanghai community health service centers.Methods A questionnaire survey on the institutional capacity for COPD care was conducted among 248 community health service centers in Shanghai from October to November 2023;the contents of self-designed questionnaire included the equipment,drugs,technical support,information exchange and management of COPD in the institutions.At the same time,a questionnaire survey on the knowledge and skill of COPD care was also conducted among half of all physicians selected by stratified sampling from half of the institutions selected by the random cluster sampling,including the knowledge about early screening,diagnosis,treatment and management of COPD,and related training needs.Results(1)Survey results showed that the most common equipment for diagnosis and treatment of COPD available in community health centers was pulse oxygen saturation detector(97.6%,242/248),X-ray radiography(96.8%,240/248)and nebulizer(96.0%,238/248),The availability of 6-min walking test system,non-invasive ventilator and rehabilitation training instrument in urban community health service centers was higher than that in rural ones(P<0.05).The availability rates of common COPD drugs in community health service centers were theophylline(91.5%,227/248),oral glucocorticoid(85.9%,213/248),intravenous glucocorticoid(81.0%,201/248),the availability of oral and intravenous glucocorticoids in urban community health service centers was higher than that in rural ones(P<0.05).The availability rates of COPD diagnosis and treatment techniques were 95.6%(213/248)for pulmonary function test,93.5%(232/248)for pulse oxygen saturation test,and 53.2%(132/248)for non-invasive respiratory therapy.The availability rate of pulmonary function test,blood gas analysis,non-invasive ventilation and rehabilitation in urban centers was higher than that in rural centers(P<0.05).Early screening of COPD was conducted in 85.1%(211/2

关 键 词：社区卫生中心 肺疾病 慢性阻塞性 诊疗质量 卫生服务管理 

分 类 号：R563.9[医药卫生—呼吸系统]