短期教育和配备肺功能仪对二级医院内科医师诊治COPD的影响
发布时间:2018-06-12 10:23
本文选题:慢性阻塞性肺疾病 + 诊断 ; 参考:《中南大学》2012年硕士论文
【摘要】:目的:了解COPD短期教育对二级医院内科医师COPD相关基本知识掌握水平的影响;了解短期教育后配备肺功能仪对二级医院内科医师诊治COPD水平的影响。方法:随机抽取湖南省8家未配备肺功能仪的二级医院,首先,在这些医院召集自愿参加COPD短期教育的门诊部和住院部内科医师,对他们进行关于COPD指南的教育讲座,并在教育前、后对内科医师进行COPD知识问卷测试,最后比较短期教育前、后问卷平均分和各题正确率之间的差异;第二阶段,COPD短期教育后立即在4家二级医院门诊免费配备肺功能仪1个月,研究者在门诊收集符合入选/排除标准的受试患者,并在受试患者就诊内科医师前为其行肺功能检查。在内科医师阅读肺功能报告前、后,他们需分别在问卷上回答受试患者是否患有COPD,若有COPD,则继续回答COPD严重程度分级及为COPD患者开处方等问题。最后比较内科医师阅读肺功能报告前、后对各题回答的差异。 结果:第一阶段,207名内科医师参与了COPD短期教育讲座,并在教育前、后分别完成COPD知识问卷测试,教育前COPD知识问卷平均分为53.14±21.73分,教育后平均分为93.33±9.75分,差异具有统计学意义(P0.001);短期教育前、后COPD知识问卷各题正确率比较,经χ2检验差异有统计学意义(P0.0001)。第二阶段,共18名门诊内科医师、307名受试患者参加了本研究,119名受试患者被诊断COPD,患病率为38.76%(119/307),其中,无呼吸系统症状COPD受试者人数为39人(32.77%)。阅读肺功能报告前、后,内科医师对受试者诊断的正确率分别为76.55%(235/307)和97.39%(299/307),差异有统计学意义(P0.0001);漏诊率分别为28.57%(34/119)和1.68%(2/119),差异有统计学意义(P0.0001);误诊率分别为20.21%(38/188)和3.19%(6/188),差异有统计学意义(P0.0001);对COPD严重程度分级诊断的正确率分别为25.21%(30/119)和87.39%(104/119),差异有统计学意义(P0.0001);对COPD严重程度分级诊断的低估率分别为40.34%(48/119)和6.72%(8/119),差异有统计学意义(P0.0001);对COPD受试患者开具处方治疗的正确率分别为18.49%(22/119)和84.03%(100/119),差异有统计学意义(P0.0001)。 结论:COPD短期教育能有效地提高内科医师对COPD相关基本知识的掌握水平;COPD短期教育联合配备肺功能仪可以提高内科医师对COPD勺正确诊断能力及对COPD严重程度正确分级的能力,开具COPD处方正确性与诊断COPD严重程度分级正确性密切正相关。
[Abstract]:Objective: to understand the influence of short term education on the level of basic knowledge of COPD among physicians in second level hospitals and the effect of equipping pulmonary function instrument on the level of diagnosis and treatment of COPD. Methods: eight second-level hospitals without pulmonary function instrument were randomly selected. First of all, physicians of outpatient and inpatient departments who volunteered to participate in short-term education of COPD were gathered in these hospitals, and they were given educational lectures on COPD guidelines. Before and after education, physicians were tested with COPD knowledge questionnaire. Finally, the differences of average score and correct rate of each question before and after short-term education were compared. The second stage of COPD short-term education immediately after the four level II hospital outpatient clinic free of charge equipped with pulmonary function instrument for one month, the researchers in the outpatient service to collect patients who meet the inclusion / exclusion criteria. The pulmonary function of the patients was examined before they were treated by a physician. Before and after the physicians read the pulmonary function report, they were asked to answer questions about whether the patients had copd and, if there was, to continue answering questions such as the severity of COPD and prescribing for COPD patients. Results: in the first stage, 207 physicians participated in the short term education lecture on COPD, and before and after the education, they completed the COPD knowledge questionnaire test, respectively. The average score of COPD knowledge questionnaire before and after education was 53.14 卤21.73 and 93.33 卤9.75, respectively, the difference was statistically significant (P 0.001), and the correct rate of COPD knowledge questionnaire before and after short term education was significantly higher than that before and after education (P 0.0001). In the second stage, a total of 18 outpatient physicians and 307 patients participated in this study. 119 of the patients were diagnosed with COPD.The prevalence rate was 38.76 / 307. The number of COPD subjects without respiratory symptoms was 38.76 / 307. The number of subjects with COPD without respiratory symptoms was 32.77g. Read the lung function report before, after, The diagnostic accuracy of physicians to the subjects were 76.55 / 235 / 307) and 97.39% respectively. The difference was statistically significant (P 0.0001); the missed diagnosis rates were 28.5757 / 34 / 119) and 1.68 / 2 / 119, respectively (P 0.0001); the misdiagnosis rates were 20.21 1 / 38 / 188) and 3.19% / 188%, respectively. The difference was statistically significant. The accuracy rates of grading diagnosis were 25.21% and 87.39% respectively, the difference was statistically significant (P 0.0001); the underestimation rate of COPD severity grading diagnosis was 40.34% 48 / 119) and 6.72% / 119 respectively, the difference was statistically significant (P 0.0001); the correct rate of prescribing treatment for COPD patients was significantly higher than that of control group (P < 0.05), and the difference was statistically significant (P < 0.05), and the difference was statistically significant (P < 0.05); the correct rate of prescribing treatment for COPD patients was significantly higher than that of control group (P < 0.05), and the difference was significant (P < 0.01). The difference is statistically significant (P 0.0001). Conclusion Short-term education of COPD can effectively improve physicians' mastery of basic knowledge related to COPD and the combination of short-term education with pulmonary function instrument can improve physicians' accuracy in COPD. Diagnostic ability and ability to correctly grade the severity of COPD, The correctness of prescribing COPD is closely related to the classification accuracy of COPD severity.
【学位授予单位】:中南大学
【学位级别】:硕士
【学位授予年份】:2012
【分类号】:R563.9
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