在初级保健中遵守GOLD指南:来自瑞士COPD队列的数据
Veronika Mangold1,2, Maria Boesing1,2, Camille Berset1,2
1University Center of Internal Medicine, Cantonal Hospital Baselland, 4410 Liestal, Switzerland.
Journal of clinical medicine
|October 28, 2023
概括
瑞士初级保健医生经常过度治疗GOLD A和B组的慢性阻塞性肺病 (COPD) 患者,偏离全球慢性阻塞性肺病 (GOLD) 倡议的指导方针. 患有严重症状或并发症的患者的坚持性更高.
科学领域:
- 肺部病理学 肺部病理学
- 初级医疗保健医学 一级医疗保健医学
- 药物治疗 药物治疗
背景情况:
- 慢性阻塞性肺病 (COPD) 对全球健康造成重大负担,需要遵守既定的管理准则.
- 全球慢性阻塞性肺病倡议 (GOLD) 提供了对COPD治疗的建议,但之前的研究表明依从程度有所变化.
- 了解在初级保健中遵守GOLD指南对于优化COPD管理和患者结果至关重要.
研究的目的:
- 评估瑞士初级保健医师是否遵守GOLD指南,用于药物治疗稳定的COPD.
- 为了识别与GOLD分类组相关的坚持和不坚持的模式.
- 探索与COPD患者的指导方针一致治疗相关的因素.
主要方法:
- 在前性瑞士COPD队列研究 (2015-2022) 中,分析了225名COPD患者的数据.
- 纳入标准:年龄≥40岁,FEV1/FVC比率<70%,吸烟史≥20包/年.
- 评估每次访问和随着时间的推移遵守GOLD指南,分析治疗处方与GOLD组建议相比.
主要成果:
- 在1163名患者访问中,治疗符合GOLD指南的65%.
- 不坚持,主要是过度治疗 (例如,A组的双重长效支气管扩展剂,A / B组的ICS),在GOLD组A (64%) 和B (33%) 中最常见.
- 在GOLD组D中观察到高坚持率 (99%).坚持指南与较高的症状负载 (CAT),更多的恶化,喘重叠和糖尿病相关.
结论:
- 在GOLD建议和初级保健实践之间存在差异,特别是在GOLD组A和B的过度治疗方面.
- 患有较高症状负担,恶化风险,喘或糖尿病的患者更有可能接受符合指南的治疗.
- 需要进一步的研究来阐明这些治疗差异的原因,并制定改善遵守GOLD指南的策略.
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