This dissertation introduces a case study on the "screen-diagnose-treat-manage" process for patients with chronic obstructive pulmonary disease Chronic obstructive pulmonary disease (COPD) under a community-level COPD prevention and treatment platform. Explored how general practitioners can utilize their unique advantages, integrate various resources, and develop treatment plans based on individual patient conditions through questionnaire surveys, lung function tests, and comprehensive evaluations, in order to achieve early identification, accurate diagnosis, effective intervention, and comprehensive care for chronic obstructive pulmonary disease. This approach provides an innovative perspective and practical pathway for managing COPD at the community level. This enhances the ability of primary healthcare providers to effectively prevent and treat chronic obstructive pulmonary disease COPD, ultimately improving patient outcomes at the community level.

本文通过介绍1例基于基层"慢阻肺防治平台"管理模式的慢性阻塞性肺疾病患者的"筛-诊-治-管"过程，探讨了全科医生如何利用平台的独特优势，整合各种资源，通过问卷调查、肺功能检查，结合综合评估，根据患者个体情况制定治疗方案，实现对慢性阻塞性肺疾病的早期识别、准确诊断、有效干预和全面照护。为基层慢性阻塞性肺疾病的管理提供了创新思路和实践路径，从而有效提升基层慢性阻塞性肺疾病防治能力。