北京市社区全科医生对慢性阻塞性肺疾病的认知现状及影响因素分析

doi:10.12114/j.issn.1007-9572.2021.00.401

摘要/Abstract

摘要： 背景　目前慢性阻塞性肺疾病（简称：慢阻肺）作为可防可控的慢性疾病，已成为我国最为突出的公共卫生与医疗问题之一，而基层社区对慢阻肺的防治尤为重要。了解社区全科医生对慢阻肺的认知能力及现况，可以更好地为开展基层社区呼吸疾病防治工作提供科学依据。目的　调查北京市社区卫生服务机构全科医生对慢阻肺的认知现状，并进行影响因素分析，为开展基层社区呼吸疾病防治工作提供科学依据。方法　于2020-09-28至10-04对北京市34家社区卫生服务中心和159家社区卫生服务站在一线工作的在职全科医生进行调查。自行设计调查问卷，共同论证后应用问卷星技术平台形成最终稿在微信工作群发布，问卷内容包括全科医生基本信息、全科医生更新学习专业知识方式、全科医生所在社区开展患者宣教方式、慢阻肺防治能力知识测试（60分及以上为及格，60分以下为不及格）。分析不同人口学特征、专业知识获得方式、所在社区开展患者宣教方式、全科医生慢阻肺防治能力知识测试及格情况，通过二元逻辑Logistic回归分析探讨社区全科医生慢阻肺防治能力知识测试及格与否的影响因素。结果　共发放1 226份问卷，回收有效问卷1 226份，问卷有效回收率100.0%。全科医生慢阻肺防治能力知识测试总平均分为（45.5±18.5）分，不及格的医生987名，及格医生239名（及格率19.5%）。其中女性医生及格率高于男性不同学历医生及格率（P<0.05）；其中研究生及以上学历医生及格率高于本科生、大专、中专及以下学历医生，本科生学历医生及格率高于大专、中专及以下学历医生（P<0.05）。不同职称等级医生及格率比较，差异有统计学意义（P<0.05）；其中高级、中级职称医生及格率高于初级职称医生（P<0.05）。通过在社区卫生服务中心/社区卫生服务站现场听院外专家授课和现场听医学会组织的专家授课的全科医生慢阻肺防治能力知识测试及格率高于不通过现场听院外专家授课和现场听医学会组织的专家授课的全科医生（P<0.05）。开展患者宣教的全科医生慢阻肺防治能力知识测试及格率高于未开展患者宣教的全科医生（P<0.05）；通过发放健康教育手册、健康教育讲座及健康咨询对患者宣教的全科医生慢阻肺防治能力知识测试及格率高于未通过发放健康教育手册、健康教育讲座、建立健康咨询对患者宣教的全科医生（P<0.05）。二元逻辑Logistic回归分析结果显示，性别、学历、职称是全科医生慢阻肺防治能力知识测试及格的影响因素（P<0.05）。结论　北京市社区卫生服务机构全科医生对慢阻肺认知不足，需进一步加强这方面培训及考核；应重点加强社区男性、低学历及低职称的全科医生在慢阻肺知识方面的培训；获取慢阻肺专业知识的方式中，在社区卫生服务中心/社区卫生服务站现场听院外专家授课及现场听医学会组织的专家授课更为有效；通过发放慢阻肺健康教育手册、进行健康教育讲座及健康咨询来进行患者教育，可以提高全科医生的慢阻肺认知水平。

关键词: 肺疾病, 慢性阻塞性；社区卫生服务机构；社区卫生中心；全科医生；认知现状；影响因素分析

Abstract: Background　At present，chronic obstructive pulmonary disease （COPD for short），as a preventable and controllable chronic disease，has become one of the most prominent public health and medical problems in our country，and the prevention and treatment of COPD in grassroots community is particularly important.Understanding the cognitive ability and current status of community general practitioners on COPD can provide a better scientific basis for the prevention and treatment of respiratory diseases in grassroots level.Objective　To investigate the status quo of cognition of COPD among general practitioners in community health service institutions in Beijing， and analyze the influencing factors to provide scientific basis for the prevention and treatment of respiratory diseases at the grassroots level.Methods　From September 28 to October 4 in 2020，a survey was conducted on the frontline general practitioners in 34 community health service centers and 159 community health service stations in Beijing. Self-designed questionnaire，after joint demonstration，the final draft of the questionnaire formed through star technology platform was published on the WeChat work group.The content of the questionnaire includes the basic information and the approaches to update and learn professional knowledge and general practitioners，the ways to carry out patient education of general practitioners，the knowledge test of COPD prevention and treatment ability（60 points or more is a pass，60 points or less is not enough）. The different demographic characteristics，approaches to obtaining professional knowledge，and the way to conduct patient education of the community health service organization and the situation about the passing of COPD prevention and control ability test of general practitioners were analyzed.And the binary Logistic regression was used to analyze the influencing factors of the prevention and control ability test of general practitioners.Results　A total of 1 226 questionnaires were distributed，and 1 226 valid questionnaires were returned.The recovery rate was 100.0%.（1）The total average score of the general practitioner's COPD knowledge test was （45.5±18.5） points，with 987 failing doctors and 239 passing doctors（pass rate 19.5%）.Among them，the passing rate of female doctors was higher than that of males（P<0.05）.The difference in the passing rate of doctors with different academic qualifications is statistically significant（P<0.05）；among them，the passing rate of doctors with master degree and above is higher than the doctors with bachelor degree，college degree，technical secondary school education and below，and the passing rate of doctors with bachelor degree is higher than doctors with college degree，technical secondary school education and below.The difference in the passing rate of doctors with different professional titles was statistically significant（P<0.05）；among them，the passing rate of doctors with senior and intermediate titles was higher than the passing rate of doctors with junior titles（P<0.05）.（2）The passing rate of general practitioners who had passed the COPD prevention and control ability knowledge test at the community health service center/community health service station by listening to the lectures by outside experts and the experts organized by the medical association was higher than the general practitioners without listening to the lectures by experts outside the hospital and the experts organized by the medical society on the spot（P<0.05）.（3）General practitioners who carried out patient education and education had a higher pass rate than those who did not carry out patient education（P<0.05）；general practitioners who disseminate health education manuals，health education lectures and health consultations to teach patients had a higher pass rate than general practitioners without distributing health education manuals，health education lectures and health consultations to teach patients.（4）The results of binary Logistic regression analysis showed that gender，educational background，and professional title were the influencing factors of general practitioners' passing knowledge test of COPD prevention and treatment （P<0.05）.Conclusion　The general practitioners in Beijing community health service institutions have insufficient knowledge of COPD，and further training and assessment in this area need to be further strengthened；emphasis should be placed on strengthening community male，low-educated and low-professional title grade practitioners in COPD knowledge training；among the approaches to obtain professional knowledge of COPD，it is more effective to listen to the lectures by experts outside the hospital at the community health service center/community health service station and the experts organized by the medical society on the spot；the general practitioner's cognitive level of COPD can be also improved through the distributing COPD health education manuals，conducting health education lectures and health consultations for patient education.

Key words: Pulmonary disease, chronic obstructive；Community health service institutions；Community health centers；General practitioner；Status quo of cognition；Root cause analysis

刘青,陈亚红2,王仲,等. 北京市社区全科医生对慢性阻塞性肺疾病的认知现状及影响因素分析[J]. 中国全科医学, 2021, 24(8): 982-988. DOI: 10.12114/j.issn.1007-9572.2021.00.401.
LIU Qing,CHEN Yahong,WANG Zhong, et al. Analysis of the Status Quo and Influencing Factors of Beijing Community General Practitioners on Chronic Obstructive Pulmonary Disease　[J]. Chinese General Practice, 2021, 24(8): 982-988. DOI: 10.12114/j.issn.1007-9572.2021.00.401.

参考文献

［1］李锋，周新.慢性阻塞性肺疾病的发病机制研究进展［J］．中国呼吸与危重监护杂志，2019，18（1）：88-92.
［2］WHO.World health statistics 2017：monitoring health for the SDGs［EB/OL］．（2017-05-17）［2019-05-05］．http://nianjian.xiaze.com/international/2017/world-health-statistics-2017.html.
［3］YIN P，WANG H，VOS T，et al．A subnational analysis of mortality and?Prevalence of COPD in China from 1990 to 2013：findings from the global burden of disease study 2013［J］．Chest，2016，150（6）：1269-1280．DOI：10.1016/j.chest.2016.08.1474.
［4］冯玉麟，王岚.中国COPD防治的难题［J］．中国呼吸与危重监护杂志，2012，11（4）：313-316．DOI：10.3969/j.issn.1671-6205.2012.04.001.
［5］VOGELMEIER C F， CRINER G J， MARTINEZ F J， et al． Global strategy for the diagnosis，management，and prevention of chronic obstructive lung disease 2017 report：GOLD executive summary［J］．Am J Respir Crit Care Med，2017，195（5）：557-582．DOI：10.1164/rccm.201701-0218PP.
［6］胡国平，钟南山，冉丕鑫，等．中国的大气污染和COPD［J］．中国胸心血管外科临床杂志，2016，23（2）：107-112．DOI：10.7507/1007-4848.20160025.
［7］WANG C，XU J，YANG L，et al．Prevalence and risk factors of chronic obstructive pulmonary disease in China（the China Pulmonary Health ［CPH］ study）：a national cross-sectional study［J］．Lancet，2018，391（10131）：1706-1717.
［8］李凡，孙惠芬，段静，等．从GOLD指南的演变看慢性阻塞性肺疾病的防治［J］．中国全科医学，2019，22（27）：3275-3280．DOI：10.12114/j.issn.1007-9572.2019.00.383.
LI F，SUN H F，DUAN J，et al．Prevention and treatment of chronic obstructive pulmonary disease from the evolution of GOLD［J］．Chinese General Practice，2019，22（27）：3275-3280．DOI：10.12114/j.issn.1007-9572.2019.00.383.
［9］李凡.从指南到实践:谈社区COPD的防治［J］．中国全科医学，2015，18（8）：865-868．DOI：10.3969/j.issn.1007-9572.2015.08.04.
LI F.From the guideline to practice: the prevention and treatment of COPD in primary care［J］．Chinese General Practice，2015，18（8）：865-868．DOI：10.3969/j.issn.1007-9572.2015.08.04.
［10］陈亚红.2019年GOLD慢性阻塞性肺疾病诊断、治疗及预防全球策略解读［J］．中国医学前沿杂志（电子版），2019，11（1）：1-14．DOI：10.12037/YXQY.2019.01-01.
［11］HAROON S，ADAB P，RLIEY R D，et al．Predicting risk of undiagnosed COPD：development and validation of the Target COPD score［J］．Eur Respir J，2017，49（6）：1602191．DOI: 10.1183/13993003.02191-2016.
［12］Asia Pacific COPD Roundtable Group.Global initiative for chronic obstructive lung disease strategy for the diagnosis， management and prevention of chronic obstructive pulmonary disease: an Asia-pacific perspective［J］．Respirology，200，10（1）：9-17．DOI：10.1111/j.1440-1843.2005.00692.x.
［13］叶亮，张静，史莹，等．基于紧密型医联体的慢阻肺社区防治网络体系建立的临床应用研究［J］．临床肺科杂志，2019，24（10）：1755-1759．DOI：10.3969/j.issn.1009-6663.2019.10.003.
YE L，ZHANG J，SHI Y，et al． Clinical application study on the establishment of a network system for COPD prevention and treatment based on close mdical consortiam［J］．Journal of Clinical Pulmonary Medicine，2019，24（10）：1755-1759．DOI：10.3969/j.issn.1009-6663.2019.10.003.
［14］赵东兴，陈淑云，周玉民，等．慢性阻塞性肺疾病社区综合防治管理平台的建立及应用效果评价［J］．中华结核和呼吸杂志，2017，40（2）:102-107．DOI：10.3760/cma.j.issn.1001-0939.2017.02.005.
［15］许扬，吴司南，张鹏俊，等．基层医生慢性阻塞性肺疾病认知现状及相关因素研究［J］．中国临床医生杂志，2017，45（6）:45-50．DOI：10.3969/j.issn.2095-8552.2017.06.014.
［16］李杉，贾存波，方方，等．我国18地区医疗机构医生慢性阻塞性肺疾病知识认知调查研究［J］．中国健康教育，2020，36（3）：195-199．DOI：10.16168/j.cnki.issn.1002-9982.2020.03.001.
LI S，JIA C B，FANG F，et al．Investigation on cognition of chronic obstructive pulmonary disease （COPD） among doctors in 18 areas of China［J］．Chinese Journal of Health Education，2020，36（3）：195-199．DOI：10.16168/j.cnki.issn.1002-9982.2020.03.001.
［17］潘美荣，王玲，卜文炳，等．上海社区医师对慢性阻塞性肺疾病相关知识认知程度调查分析［J］．实用老年医学，2016，30（10）：809-811．DOI：10.3969/j.issn.1003-9198.2016.10.007.
［18］陈明敏，叶康丽，徐志杰，等．我国慢性阻塞性肺疾病社区管理现状与展望［J］．中国全科医学，2020，23（3）：251-256．DOI：10.12114/j.issn.1007-9572.2019.00.756.
CHEN M M，YE K L，XU Z J，et al．Current situation and prospect of chronic obstructive pulmonary disease community management in China［J］．Chinese General Practice，2020，23（3）:251-256．DOI：10.12114/j.issn.1007-9572.2019.00.756.
［19］董婷，胥馨尹，季奎，等．四川省40岁及以上人群慢阻肺相关知识知晓情况分析［J］．预防医学情报杂志，2020，36（2）：166-171，176.
DONG T，XU X Y，JI K，et al．Awareness of knowledge about chronic obstructive pulmonary disease in residents aged 40 and above in Sichuan province［J］．Journal of Preventive Medicine Information，2020，36（2）：166-171，176.
［20］JESSICA LI，王辞晓，吴峰.成人在线学习自我效能感量表编制及测量［J］．远程教育杂志，2015，33（6）：47-53．DOI：10.3969/j.issn.1672-0008.2015.06.007.
［21］肖涛，尹朝霞，蔡澍，等．北京市全科医生慢性心力衰竭相关知识及影响因素调查［J］．中华全科医师杂志，2014，13（4）：276-280．DOI：10.3760/cma.j.issn.1671-7368.2014.04.012.
［22］郑富豪，沈金波.聚类分析和关联分析在三级甲等医院科研绩效评价中的应用［J］．中国医疗管理科学，2020，10（6）：23-28．DOI：10.3969/j.issn.2095-7432.2020.06.005.
ZHENG F H，SHEN J B.Application of cluster and association analyses in research performance assessment in a grade A tertiary hospital［J］．China Medical Administration Sciences，2020，10（6）：23-28．DOI：10.3969/j.issn.2095-7432.2020.06.005.
［23］甘天翊，刘妮妮，张宇辉，等．内科医生对心力衰竭指南知识的掌握情况调查［J］．中国循环杂志，2017，32（10）：952-955．DOI：10.3969/j.issn.1000-3614.2017.10.005.
GAN T Y，LIU N N，ZHANG Y H，et al．A knowledge survey on heart failure guidelines in physicians［J］．Chinese Circulation Journal，2017，32（10）：952-955．DOI：10.3969/j.issn.1000-3614.2017.10.005.
［24］余永超，林嘉明，梁跃.基层医生对慢性阻塞性肺疾病的认知现状及相关影响因素［J］．深圳中西医结合杂志，2020，30（17）：20-21．DOI：10.16458/j.cnki.1007-0893.2020.17.010.

[1]	刘健, 张天一, 艾力扎提·艾则孜, 常蕊静, 张建立, 王婉, 姜鹏. 外科口罩和N95口罩对慢性阻塞性肺疾病患者心肺功能的影响：一项随机交叉对照试验[J]. 中国全科医学, 2023, 26(24): 3028-3032.
[2]	冯佳, 王洁, 余丹, 刘永恒, 赵伟栋, 田宏远. 2010—2021年国内外老年多重慢病研究热点分析[J]. 中国全科医学, 2023, 26(21): 2574-2580.
[3]	沈俊希, 朱星, 陈云志, 李文. 肺部、肠道菌群及其相互作用与慢性阻塞性肺疾病发生发展的研究进展[J]. 中国全科医学, 2023, 26(20): 2548-2554.
[4]	梁振宇, 王凤燕, 陈子正, 陈荣昌. 2023年GOLD慢性阻塞性肺疾病诊断、管理及预防全球策略更新要点解读[J]. 中国全科医学, 2023, 26(11): 1287-1298.
[5]	王通, 权海善, 田博文, 李莹, 崔倩倩, 刘瑶, 朱花花. 慢性阻塞性肺疾病患者疲劳研究的范围综述[J]. 中国全科医学, 2023, 26(07): 893-902.
[6]	刘建材, 郑涵尹, 潘卉, 叶灵兰, 李传芬. 农村地区基层慢性病管理人员对慢性阻塞性肺疾病认知的调查研究[J]. 中国全科医学, 2023, 26(07): 877-885.
[7]	王益德, 李争, 李风森. 从脂肪组织的内分泌功能角度探讨其在慢性阻塞性肺疾病中的作用机制研究[J]. 中国全科医学, 2023, 26(06): 754-759.
[8]	石伟娟, 王凤燕, 杨宇琼, 谢清秀, 李玉琪, 李时悦, 陈荣昌, 张冬莹, 郑劲平, 梁振宇. 新型冠状病毒感染疫情对慢性阻塞性肺疾病患者急性加重频率的影响研究[J]. 中国全科医学, 2023, 26(05): 550-556.
[9]	胡奕卿, 方继伟, 刘焕兵. 肺功能检查技术如何在基层医疗卫生服务中更好地应用——附重点问题专家解答[J]. 中国全科医学, 2023, 26(05): 532-540.
[10]	白亚虎, 高胜寒, 纪思禹, 尚金钰, 董延春, 宁康. 慢性阻塞性肺疾病向"前"发展[J]. 中国全科医学, 2023, 26(03): 268-273.
[11]	郭栋伟, 张鹏飞, 任明君, 廖丽君, 黄茹妍, 罗湘蓉. 银杏叶提取物防治慢性阻塞性肺疾病的机制研究：基于PI3K/Akt/mTOR信号通路调控肺泡巨噬细胞自噬[J]. 中国全科医学, 2023, 26(03): 293-303.
[12]	徐莉莉, 洪赟晢, 李智慧, 于宁霞, 邸家琪, 杨曙光, 林青青, 余学庆. 特发性肺纤维化预后标志物的研究进展[J]. 中国全科医学, 2023, 26(03): 372-379.
[13]	方紫妍, 李雪儿, 杨雪凝, 柳静, 杨从艳, 章凤, AKIMANA Sandra, 汪艳, 张静. 疲劳对慢性阻塞性肺疾病患者急性加重影响的前瞻性队列研究[J]. 中国全科医学, 2023, 26(03): 287-292.
[14]	黄桃, 罗娜, 罗松, 徐钦. 具有双通道通气和恒定泄气量功能的新型无创正压通气面罩治疗慢性阻塞性肺疾病急性加重合并CO₂潴留患者的临床效果研究[J]. 中国全科医学, 2023, 26(03): 343-347.
[15]	巫建康, 陈燕. 慢性阻塞性肺疾病的新定义及临床诊疗建议——基于2022年《柳叶刀》文件解读[J]. 中国全科医学, 2023, 26(02): 127-133.