上海市社区卫生服务中心慢性阻塞性肺疾病防控能力分析

杨群娣; 苏秋云; 陈晓英; 郑杨; 刘丹妮; 刘晓侠; 施燕; 付晨

doi:10.16766/j.cnki.issn.1674-4152.002903

上海市社区卫生服务中心慢性阻塞性肺疾病防控能力分析

doi: 10.16766/j.cnki.issn.1674-4152.002903

杨群娣¹,
苏秋云¹,
陈晓英¹,
郑杨¹,
刘丹妮¹,
刘晓侠¹,
施燕^{1, 2},
付晨^1, ,

1.
上海市疾病预防控制中心，上海 200336
2.
国家老年疾病临床医学研究中心，上海 200040

基金项目:

上海市卫生健康委员会科研面上项目 202140490

详细信息

通讯作者:
付晨, E-mail: fuchen@scdc.sh.cn

中图分类号: R563R197.61
计量
- 文章访问数: 296
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- PDF下载量: 20
- 被引次数: 0
出版历程
- 收稿日期: 2022-02-08
- 网络出版日期: 2023-04-19

Capacity for chronic obstructive pulmonary disease prevention and control of community health service centers in Shanghai

1.
Shanghai Municipal Center for Disease Control & Prevention, Shanghai 200336, China

摘要

摘要: 目的了解上海市社区卫生服务中心慢性阻塞性肺疾病(COPD)防控能力，为进一步推动COPD防控工作提供依据。方法采用自行设计的问卷，对上海市所有社区卫生服务中心进行调查，主要内容包括COPD诊断所需设备、治疗药物的配置以及防控工作情况等。结果 242家社区卫生服务中心中，配备肺功能检测仪的比例为28.51%，提供肺功能检测服务的比例为19.83%。配备X线机的比例为97.52%。三类常用治疗药物支气管扩张剂、吸入糖皮质激素、磷酸二酯酶-4抑制剂的配备比例分别为93.80%、34.30%、6.61%，配备长效β2受体激动剂和长效抗胆碱能制剂的社区比例分别为30.58%和19.01%。在开展的COPD防控工作上，开展COPD健康教育工作的机构占比为50.83%，主要形式有讲座、主题宣传日活动和发放宣传材料等；16家(6.61%)开展过COPD主动筛查工作，其中采用问卷和简易肺功能检测联用10家，采用简易肺功能检测6家；开展高危人群管理和患者社区管理的机构比例分别为4.13%、18.18%，主要干预内容为健康教育、危险因素干预和定期评估。结论上海市社区卫生服务中心COPD防控工作尚处起步阶段，诊治相关的配置还需加强。
- 上海 /
- 社区卫生服务中心 /
- 慢性阻塞性肺疾病 /
- 防控
Abstract: Objective To evaluate the capacity for chronic obstructive pulmonary disease (COPD) prevention and control of community health service centers in Shanghai in order to improve future work. Methods A self-designed questionnaire survey was conducted to investigate the progression on prevention and control of COPD and the related equipment and drugs among all community health service centers in Shanghai. Results Among the 242 community health service centers, 28.51% were equipped with spirometer while 19.83% provided pulmonary function testing service. Community health service centers equipped with X-ray machines account for 97.52%. The proportion of community health service centers providing bronchodilators, glucocorticoids, and phosphodiesterase inhibitors were 93.80%, 34.30%, and 6.61%, respectively. The percentage of community health service centers providing long-acting beta2-agonists and long-acting muscarinic antagonists were 30.58% and 19.01%. In terms of COPD prevention and control, 50.83% of the centers carried out COPD health education, mainly in the form of lectures, theme publicity day activities and distribution of publicity materials. Total 16 (6.61%) community health service centers had carried out COPD active screening, of which 10 used questionnaires combined with simple pulmonary function test, and 6 used simple pulmonary function tests. The proportion carrying out the projects on high-risk population management and patient community management were 4.13% and 18.18%. The main intervention contents included health education, risk factor intervention and regular assessment. Conclusion The prevention and control of COPD in community health service centers in Shanghai is still in its infancy, and the related equipment and facilities of diagnosis and treatment needs to be strengthened.
- Shanghai /
- Community health service center /
- Chronic obstructive pulmonary disease /
- Prevention and control

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表 1 社区卫生服务中心COPD防治相关设备和药物配备情况(n=242)

Table 1. Allocation of COPD prevention and control equipment and drugs in community health service centers (n=242)

类别	种类	配备的社区卫生服务中心数量(家)	比例(%)
诊断设备
	肺功能检测仪	69	28.51
	大型	1	0.41
	便携式	68	28.10
	X线机	236	97.52
治疗药物
	支气管扩张剂	227	93.80
	β2受体激动剂	218	90.08
	抗胆碱能	106	43.80
	β2受体激动剂与抗胆碱能复方制剂	30	12.40
	甲基黄嘌呤类	107	44.21
	吸入糖皮质激素	83	34.30
	β2受体激动剂与糖皮质激素复方制剂	47	19.42
	磷酸二酯酶-4抑制剂	16	6.61

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表 2 社区卫生服务中心COPD防控工作开展情况(n=242)

Table 2. COPD prevention and control in community health service centers (n=242)

类别	工作内容	相关工作开展的社区卫生服务中心数量(家)	比例(%)
健康教育		123	50.83
	讲座	108	44.63
	主题宣传日活动	88	36.36
	宣传材料制作发放	89	36.78
主动筛查		16	6.61
	筛查问卷+简易肺功能检测	10	4.13
	简易肺功能检测	6	2.48
高危人群管理与干预		10	4.13
	健康教育	10	4.13
	危险因素干预	10	4.13
	定期评估	10	4.13
患者管理与干预		44	18.18
	健康教育	43	17.77
	危险因素干预	39	16.12
	定期评估	32	13.22
	用药指导	32	13.22
	肺功能锻炼指导	26	10.74
	家庭氧疗指导	16	6.61
	终末期护理或临终关怀	5	2.07
	肺康复运动指导	4	1.65
	家用机械通气支持	3	1.24

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参考文献(16)

[1]	ZHOU M G, WANG H D, ZENG X Y, et al. Articles Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017[J]. Lancet, 2019, 6736(19): 1-14.
[2]	WANG C, XU J Y, 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. doi: 10.1016/S0140-6736(18)30841-9
[3]	孙永昌. 慢性阻塞性肺疾病在中国基层医疗机构面临的挑战和应对[J]. 中华结核和呼吸杂志, 2020, 43(1): 14-16. doi: 10.3760/cma.j.issn.1001-0939.2020.01.005 SUN Y C. Chronic obstructive pulmonary disease: challenges for primary care in China[J]. Chinese Journal of Tuberculosis and Respiratory Diseases, 2020, 43(1): 14-16. doi: 10.3760/cma.j.issn.1001-0939.2020.01.005
[4]	许扬, 张鹏俊, 杨汀, 等. 我国基层慢性阻塞性肺疾病防治现状研究[J]. 中国全科医学, 2016, 19(34): 4153-4158. doi: 10.3969/j.issn.1007-9572.2016.34.001 XU Y, ZHANG P J, YANG T, et al. Current status of prevention and control of chronic obstructive pulmonary disease in primary care in China[J]. Chinese General Practice, 2016, 19(34): 4153-4158. doi: 10.3969/j.issn.1007-9572.2016.34.001
[5]	国务院办公厅. 国务院办公厅关于印发中国防治慢性病中长期规划(2017—2025年)的通知[EB/OL]. (2017-02-14)[2019-12-10]. http://www.gov.cn/zhengce/content/2017-02/14/content_5167886.htm. General Office of the State Council. Circular of the General Office of the State Council on Printing and Distributing National Medium and Long-term Plan on Prevention and Control of Noncommunicable Diseases (2017-2025)[EB/OL]. (2017-02-14)[2019-12-10]. http://www.gov.cn/zhengce/content/2017-02/14/content_5167886.htm.
[6]	健康中国行动推进委员会. 健康中国行动(2019—2030年)[EB/OL]. (2019-07-15)[2019-12-10]. http://www.gov.cn/xinwen/2019-07/15/content_5409694.htm. Healthy China Initiative Promotion Committee. Healthy China initiative[EB/OL]. (2019-07-15)[2019-12-10]. http://www.gov.cn/xinwen/2019-07/15/content_5409694.htm.
[7]	李鑫, 王猛. 慢性阻塞性肺疾病社区卫生服务的研究进展[J]. 中国慢性病预防与控制, 2019, 27(8): 634-637. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMXB201908021.htm LI X, WANG M. Research progress of community health service for chronic obstructive pulmonary disease[J]. Chinese Journal of Prevention and Control of Chronic Diseases, 2019, 27(8): 634-637. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMXB201908021.htm
[8]	徐绮, 薛锦花, 刘连勇, 等. 某社区中年人群糖尿病患者综合管理现况与分析[J]. 中华全科医学, 2017, 15(8): 1374-1377. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.030 XU Q, XUE J H, LIU L Y. The investigation and analysis of comprehensive management in middle aged diabetes mellitus in a Shanghai based community[J]. Chinese Journal of General Practice, 2017, 15(8): 1374-1377. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.030
[9]	彭博, 张鹏俊, 吴司南, 等. 我国基层医疗卫生机构慢性呼吸系统疾病管理现状研究[J]. 中国全科医学, 2018, 21(13): 1513-1520. doi: 10.3969/j.issn.1007-9572.2018.13.001 PENG B, ZHANG P J, WU S N, et al. Chronic respiratory disease management in grassroots medical institutions of China[J]. Chinese General Practice, 2018, 21(13): 1513-1520. doi: 10.3969/j.issn.1007-9572.2018.13.001
[10]	沈宁, 贺蓓. 肺功能检查在慢性阻塞性肺疾病诊断及治疗中的临床意义[J]. 中华结核和呼吸杂志, 2019, 42(1): 73-76. doi: 10.3760/cma.j.issn.1001-0939.2019.01.023 SHEN N, HE B. Clinical significance of lung function test in the diagnosis and treatment of chronic obstructive pulmonary disease[J]. Chinese Journal of Tuberculosis and Respiratory Diseases, 2019, 42(1): 73-76. doi: 10.3760/cma.j.issn.1001-0939.2019.01.023
[11]	中华医学会, 中华医学会杂志社, 中华医学会全科医学分会, 等. 常规肺功能检查基层指南(2018年)[J]. 中华全科医师杂志, 2019, 18(6): 511-518. doi: 10.3760/cma.j.issn.1671-7368.2019.06.003 Chinese Medical Association, Chinese Medical Journals Publishing House, Chinese Society of General Practice, et al. Guideline for pulmonary function testing in primary care (2018)[J]. Chinese Journal of General Practitioners, 2019, 18(6): 511-518. doi: 10.3760/cma.j.issn.1671-7368.2019.06.003
[12]	方利文, 包鹤龄, 王宝华, 等. 2014年中国40岁及以上人群肺功能检查率调查与分析[J]. 中华流行病学杂志, 2018, 39(5): 593-599. doi: 10.3760/cma.j.issn.0254-6450.2018.05.010 FANG L W, BAO H L, WANG B H, et al. Survey and analyses of rate of spirometry examination in adults aged 40 years and older in China, 2014[J]. Chinese Journal of Epidemiology, 2018, 39(5): 593-599. doi: 10.3760/cma.j.issn.0254-6450.2018.05.010
[13]	中华医学会, 中华医学会杂志社, 中华医学会全科医学分会, 等. 慢性阻塞性肺疾病基层诊疗指南(2018年)[J]. 中华全科医师杂志, 2018, 17(11): 856-870. doi: 10.3760/cma.j.issn.1671-7368.2018.11.002 Chinese Medical Association, Chinese Medical Journals Publishing House, Chinese Society of General Practice, et al. Guideline for primary care of chronic obstructive pulmonary disease (2018)[J]. Chinese Journal of General Practitioners, 2018, 17(11): 856-870. doi: 10.3760/cma.j.issn.1671-7368.2018.11.002
[14]	Global initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of Chronic Obstructive Pulmonary Disease (2020 report)[EB/OL]. (2019-12-03)[2021-07-02]. https://goldcopd.org/wp-content/uploads/2019/12/GOLD-2020-FINAL-ver1.2-03Dec19_WMV.pdf.
[15]	中华医学会呼吸病学分会慢性阻塞性肺疾病学组, 中国医师协会呼吸医师分会慢性阻塞性肺疾病工作委员会. 慢性阻塞性肺疾病诊治指南(2021年修订版)[J]. 中华结核和呼吸杂志, 2021, 44(3): 170-205. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX202129002.htm Chronic Obstructive Pulmonary Disease Group of Chinese Thoracic Society, Chronic Obstructive Pulmonary Disease Committee of Chinese Association of Chest Physician. Guidelines for the diagnosis and management of chronic obstructive pulmonary disease (revised version 2021)[J]. Chinese Journal of Tuberculosis and Respiratory Diseases, 2021, 44(3): 170-205. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX202129002.htm
[16]	肖甜, 陈晓英, 王娜, 等. 中国大城市社区慢性阻塞性肺部疾病患者药物使用现状研究[J]. 中华流行病学杂志, 2017, 38(2): 142-146. XIAO T, CHEN X Y, WANG N, et al. Study on the situation of drug use in patients with chronic obstructive pulmonary diseases in the Chinese communities of large cities[J]. Chinese Journal of Epidemiology, 2017, 38(2): 142-146.