上海社区支气管哮喘诊疗及管理能力现况调查  

A cross-sectional study on diagnosis,treatment and management of bronchial asthma in communities of Shanghai

作　　者：郭爱珍 于德华 周英达 何柳华 陈晨 金花 GUO Aizhen;YU Dehua;ZHOU Yingda;HE Liuhua;CHEN Chen;JIN Hua(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)

机构地区：[1]上海市杨浦区中心医院(同济大学附属杨浦医院)全科,上海200090

出　　处：《上海医学》2025年第1期32-37,共6页Shanghai Medical Journal

基　　金：国家自然科学基金(72104183);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);上海市杨浦区中心医院第十二批攀登计划(Ye2202302)。

摘　　要：目的从社区卫生服务中心和社区医师两个维度调查支气管哮喘(以下简称哮喘)的社区诊疗质量及管理能力。方法采用横断面调查方法,于2023年10—11月,采用自制问卷对上海市社区卫生服务中心的哮喘诊疗设备、药品、技术支持、信息互通、管理内容等进行调查;同时,通过随机整群抽样的方法,抽取各行政区1/2的社区卫生服务中心,被抽中的社区按技术职称进行分层,抽取50%医师进行问卷调查,内容包括哮喘临床表现、诊断和治疗、稳定期管理、诊疗难点等。城、郊区社区卫生服务中心组间设备可获得性、药品可获得性、哮喘诊疗技术和管理内容等的比较采用χ^(2)检验。结果共调查上海市248家社区卫生服务中心。社区卫生服务中心诊疗设备获得率从高到低依次是X线摄片仪96.8%(240/248)、肺功能检查仪95.6%(237/248)、CT仪48.4%(120/248)、呼出气一氧化氮(FeNO)检测仪24.5%(61/248)、呼气流量峰值(PEF)检测仪14.1%(35/248),其中郊区CT仪的获得率高于城区(χ^(2)=7.78,P<0.01)。药品获得率从高到低位于前5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)、短效β_(2)受体激动剂79.1%(196/248)和中成药77.8%(193/248)。其中,郊区的口服糖皮质激素和静脉用糖皮质激素的可获得率显著高于城区(P值均<0.05)。诊疗技术开展率从高到低依次为肺通气功能检查85.9%(213/248)、支气管舒张试验35.5%(88/248)、支气管激发试验9.3%(23/248),其中城区肺通气功能检查开展率高于郊区(P<0.05)。城区社区哮喘健康档案建档率显著高于郊区(P<0.05)。2140名社区医师问卷调查结果显示,社区医师对哮喘诊疗和管理知识掌握程度不一,掌握最差的知识点前5位依次为哮喘控制性药物和缓解性药物分类8.8%(189/2140)、哮喘临床分期17.7%(378/2140)、哮喘长期管理目标24.3%(521/2140)、肺功能表现�Objective To investigate the diagnosis,treatment and management of bronchial asthma from the perspectives of community health centers and community physicians.Methods This was a cross-sectional study.A self-designed questionnaire was used to investigate the equipment,drugs,technical support,information exchange and management of asthma in community health centers in Shanghai from October to November 2023.Meanwhile,half of the community health centers in each administrative region were selected by random cluster sampling,and a questionnaire survey was conducted on 50%of the doctors stratified according to their technical titles in the selected communities.The contents of investigation contained clinical manifestations of asthma,diagnosis and treatment,management of stable period,difficulties in diagnosis and treatment,etc.The equipment availability,drug availability,diagnosis and treatment technology,and management between urban and suburban community health centers were compared by usingχ^(2) test.Results A total of 248 community health centers were enrolled in this study.The acquisition rate of diagnostic and treatment equipment in community health centers was as follows(from high to low):X-ray radiography(96.8%,240/248),pulmonary function test detector(95.6%,237/248),CT(48.4%,120/248),FeNO detector(24.5%,61/248),and PEF detector(14.1%,35/248).The acquisition rate of CT in the suburbs was higher than that in the urban area(χ^(2)=7.78,P<0.01).The top five obtainable drugs were theophylline(91.5%,227/248),oral glucocorticoid(85.9%,213/248),intravenous glucocorticoid(81.0%,201/248),short-actingβ_(2)-agonists(79.1%,196/248),and Chinese patent medicine(77.8%,193/248).The availability of oral glucocorticoids and intravenous glucocorticoids in the suburbs was significantly higher than that in the urban area(P<0.05).The top techniques applied in community health centers were pulmonary ventilation function test(85.9%,213/248),bronchial dilation test(35.5%,88/248),and bronchial provocation test(9.3%,23/248).The applica

关 键 词：社区卫生中心 支气管哮喘 诊疗质量 卫生服务管理 

分 类 号：R562.25[医药卫生—呼吸系统]