Cargando…
Stable Chronic Obstructive Pulmonary Disease (COPD) Management Under a Tiered Medical System in China
BACKGROUND: Early diagnosis and proper management of a large number of chronic obstructive pulmonary disease (COPD) patients are great challenges for the Chinese health care system. Although tiered medical services have been promoted by the Chinese government since 2015, they have not been ideally i...
Autores principales: | , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Dove
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8765268/ https://www.ncbi.nlm.nih.gov/pubmed/35058691 http://dx.doi.org/10.2147/COPD.S333274 |
_version_ | 1784634306337964032 |
---|---|
author | Mao, Ruolin Liu, Zilong Zhao, Yunfeng Du, Chunlin Zhou, Jintao Wang, Qian Lu, Jinchang Gao, Lei Cui, Bo Ma, Yuan Sun, Tieying Zhu, Lei Chen, Zhihong |
author_facet | Mao, Ruolin Liu, Zilong Zhao, Yunfeng Du, Chunlin Zhou, Jintao Wang, Qian Lu, Jinchang Gao, Lei Cui, Bo Ma, Yuan Sun, Tieying Zhu, Lei Chen, Zhihong |
author_sort | Mao, Ruolin |
collection | PubMed |
description | BACKGROUND: Early diagnosis and proper management of a large number of chronic obstructive pulmonary disease (COPD) patients are great challenges for the Chinese health care system. Although tiered medical services have been promoted by the Chinese government since 2015, they have not been ideally implemented for COPD diagnosis and management. PATIENTS AND METHODS: We designed a cross-sectional study. Eligible COPD patients (n = 648) and physicians (n = 161) were consecutively recruited from 8 hospitals in different tiers in China. COPD characteristics and treatments were compared among hospitals in different tiers. Multivariate logistic regression was performed to identify risk factors associated with airflow limitation, symptoms and acute exacerbation. RESULTS: The PFT rate at first diagnosis was 99%, 69.4% and 29.9% in teaching, second-tier and community hospitals (P < 0.001). Only approximately 10.9%, 1.7% and 9.6% and 21.8%, 6.9% and 32% of COPD patients received influenza or pneumococcal vaccines (P < 0.001). The proportion of patients who did not use inhaled drugs or had irregular inhalation was 2%, 24.6% and 78.8% (P < 0.001). Education level (RR-1 = −41.26%, P = 0.007), FEV1%pred (RR-1 = −2.76%, P < 0.001), and influenza vaccination in the last year (RR-1 = −64.53%, P = 0.006) were all negatively correlated with COPD acute exacerbation (AE). COPD duration (RR-1 = 131.73%, P = 0.009), AE (RR-1 = 151.39%, P < 0.001), and COPD Assessment Test (CAT) scores (RR-1 = 3.82%, P = 0.019) were all positively correlated with COPD airflow limitation severity. CONCLUSION: Differences exist in the diagnosis, treatment and management of COPD among different tiers of hospitals in China. Teaching hospitals can manage COPD patients relatively well. There are still some gaps compared with developed countries. |
format | Online Article Text |
id | pubmed-8765268 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Dove |
record_format | MEDLINE/PubMed |
spelling | pubmed-87652682022-01-19 Stable Chronic Obstructive Pulmonary Disease (COPD) Management Under a Tiered Medical System in China Mao, Ruolin Liu, Zilong Zhao, Yunfeng Du, Chunlin Zhou, Jintao Wang, Qian Lu, Jinchang Gao, Lei Cui, Bo Ma, Yuan Sun, Tieying Zhu, Lei Chen, Zhihong Int J Chron Obstruct Pulmon Dis Original Research BACKGROUND: Early diagnosis and proper management of a large number of chronic obstructive pulmonary disease (COPD) patients are great challenges for the Chinese health care system. Although tiered medical services have been promoted by the Chinese government since 2015, they have not been ideally implemented for COPD diagnosis and management. PATIENTS AND METHODS: We designed a cross-sectional study. Eligible COPD patients (n = 648) and physicians (n = 161) were consecutively recruited from 8 hospitals in different tiers in China. COPD characteristics and treatments were compared among hospitals in different tiers. Multivariate logistic regression was performed to identify risk factors associated with airflow limitation, symptoms and acute exacerbation. RESULTS: The PFT rate at first diagnosis was 99%, 69.4% and 29.9% in teaching, second-tier and community hospitals (P < 0.001). Only approximately 10.9%, 1.7% and 9.6% and 21.8%, 6.9% and 32% of COPD patients received influenza or pneumococcal vaccines (P < 0.001). The proportion of patients who did not use inhaled drugs or had irregular inhalation was 2%, 24.6% and 78.8% (P < 0.001). Education level (RR-1 = −41.26%, P = 0.007), FEV1%pred (RR-1 = −2.76%, P < 0.001), and influenza vaccination in the last year (RR-1 = −64.53%, P = 0.006) were all negatively correlated with COPD acute exacerbation (AE). COPD duration (RR-1 = 131.73%, P = 0.009), AE (RR-1 = 151.39%, P < 0.001), and COPD Assessment Test (CAT) scores (RR-1 = 3.82%, P = 0.019) were all positively correlated with COPD airflow limitation severity. CONCLUSION: Differences exist in the diagnosis, treatment and management of COPD among different tiers of hospitals in China. Teaching hospitals can manage COPD patients relatively well. There are still some gaps compared with developed countries. Dove 2022-01-14 /pmc/articles/PMC8765268/ /pubmed/35058691 http://dx.doi.org/10.2147/COPD.S333274 Text en © 2022 Mao et al. https://creativecommons.org/licenses/by-nc/3.0/This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/ (https://creativecommons.org/licenses/by-nc/3.0/) ). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). |
spellingShingle | Original Research Mao, Ruolin Liu, Zilong Zhao, Yunfeng Du, Chunlin Zhou, Jintao Wang, Qian Lu, Jinchang Gao, Lei Cui, Bo Ma, Yuan Sun, Tieying Zhu, Lei Chen, Zhihong Stable Chronic Obstructive Pulmonary Disease (COPD) Management Under a Tiered Medical System in China |
title | Stable Chronic Obstructive Pulmonary Disease (COPD) Management Under a Tiered Medical System in China |
title_full | Stable Chronic Obstructive Pulmonary Disease (COPD) Management Under a Tiered Medical System in China |
title_fullStr | Stable Chronic Obstructive Pulmonary Disease (COPD) Management Under a Tiered Medical System in China |
title_full_unstemmed | Stable Chronic Obstructive Pulmonary Disease (COPD) Management Under a Tiered Medical System in China |
title_short | Stable Chronic Obstructive Pulmonary Disease (COPD) Management Under a Tiered Medical System in China |
title_sort | stable chronic obstructive pulmonary disease (copd) management under a tiered medical system in china |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8765268/ https://www.ncbi.nlm.nih.gov/pubmed/35058691 http://dx.doi.org/10.2147/COPD.S333274 |
work_keys_str_mv | AT maoruolin stablechronicobstructivepulmonarydiseasecopdmanagementunderatieredmedicalsysteminchina AT liuzilong stablechronicobstructivepulmonarydiseasecopdmanagementunderatieredmedicalsysteminchina AT zhaoyunfeng stablechronicobstructivepulmonarydiseasecopdmanagementunderatieredmedicalsysteminchina AT duchunlin stablechronicobstructivepulmonarydiseasecopdmanagementunderatieredmedicalsysteminchina AT zhoujintao stablechronicobstructivepulmonarydiseasecopdmanagementunderatieredmedicalsysteminchina AT wangqian stablechronicobstructivepulmonarydiseasecopdmanagementunderatieredmedicalsysteminchina AT lujinchang stablechronicobstructivepulmonarydiseasecopdmanagementunderatieredmedicalsysteminchina AT gaolei stablechronicobstructivepulmonarydiseasecopdmanagementunderatieredmedicalsysteminchina AT cuibo stablechronicobstructivepulmonarydiseasecopdmanagementunderatieredmedicalsysteminchina AT mayuan stablechronicobstructivepulmonarydiseasecopdmanagementunderatieredmedicalsysteminchina AT suntieying stablechronicobstructivepulmonarydiseasecopdmanagementunderatieredmedicalsysteminchina AT zhulei stablechronicobstructivepulmonarydiseasecopdmanagementunderatieredmedicalsysteminchina AT chenzhihong stablechronicobstructivepulmonarydiseasecopdmanagementunderatieredmedicalsysteminchina |