上海市浦东新区社区全科医生COPD诊疗及认知水平现状调查

Survey on the Current Status of COPD Diagnosis, Treatment, and Awareness among Community General Practitioners in Pudong New Area, Shanghai

摘要: 目的：了解上海市浦东新区社区卫生服务中心慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)当前诊疗现状和全科医师对该项疾病认知及管理能力。方法：于2025年3月25至5月20日利用问卷星向浦东新区46家社区卫生服务中心发送机构问卷，了解当前社区诊疗设备及药物覆盖等情况，同时按地区(偏远农村、一般农村、城郊结合、城区)对医院进行分层，每层随机抽取115名医师，对其进行COPD诊疗能力相关问题的问卷调查。采用χ²检验比较浦东新区4个地区的社区卫生服务中心诊疗设备和药品配备率、诊疗技术开展情况。机构问卷回收率100%，医师问卷回收率99.35% (457/460)。采用logistic回归分析不同因素对基层全科医生COPD诊疗及管理的影响，设P < 0.05为差异有统计学意义。结果：上海市浦东新区46家社区卫生服务中心的诊疗设备获得率从高到低依次是血细胞分析仪(100%)、肺功能仪(100%)、胸部X片(100%)、胸部CT (100%)、心电图(100%)、血氧饱和度仪(100%)、氧疗设备(100%)、雾化吸入设备(100%)、心脏彩超(89.1%)、呼出气一氧化氮(fractional exhaled nitricoxide, FeNO) (69.6%)、6分钟步行试验(30.4%)、血气分析(6.5%)，其中一般农村地区血气配备率最高，城区心脏彩超、FeNO、6分钟步行试验配备率最高，4个地区差异无统计学意义(P > 0.05)。吸入药品配备情况从高到低依次为雾化吸入糖皮质激素(100%)、雾化吸入支气管扩张剂(95.7%)、吸入用糖皮质激素联合一种支气管扩张剂(91.3%) 、短效吸入性支气管舒张剂(87%)、长效吸入性支气管舒张剂(73,9%)、三联药物(71.7%)、联合支气管扩张剂(23.9%)。在口服及静脉药物方面，配备情况从高到低依次为抗菌药物(100%)、止咳祛痰药物(100%)、呼吸相关中药(100%)、糖皮质激素(82.6%)、支气管扩张剂(80.4%)、抗病毒药物(65.2%)、磷酸二酯酶抑制剂(23.9%)。4个地区之间的药物覆盖情况差异无统计学意义。目前浦东新区咳喘门诊开设率为43.5%(20/46)，所有中心均已开展肺通气功能检查和支气管舒张试验，但均未开展支气管激发试验，4个地区比较差异无统计学意义(P > 0.05)。457名社区医师问卷调查结果显示，社区医师对COPD诊疗和管理知识掌握程度不一，掌握最差的知识点前5位依次为COPD药物治疗方法、COPD分组方法、运用CAT及mMRC问卷能力、COPD高危人群识别、肺功能报告判读。通过logistic回归分析发现，医生对COPD诊断及分级的掌握程度、肺功能判读、转诊指征的认知、指导吸入装置能力均与培训次数有关。结论：上海市浦东新区社区卫生服务中心COPD诊疗设备及药品覆盖率高，但关键药物仍有短板，且使用能力不足。社区全科医生对COPD诊疗知识有一定的了解，但是掌握程度不够深入，临床应用能力欠佳，缺乏接诊自信，增加培训次数和提高培训质量或许能帮助医生提升COPD诊疗能力。

Abstract: Objective: To investigate the current diagnosis and treatment status of chronic obstructive pulmonary disease (COPD) in community health service centers in Pudong New Area, Shanghai, as well as general practitioners’ knowledge and management capabilities regarding this disease. Methods: From March 25 to May 20, 2025, institutional questionnaires were distributed via Questionnaire Star to 46 community health service centers in Pudong New Area to evaluate the availability of diagnostic equipment and medications. Physicians were stratified by region (remote rural, general rural, suburban, urban), with 115 GPs randomly selected from each stratum for COPD management capability assessment. χ² tests compared equipment and medication coverage and technical capacity across regions. Institutional questionnaire response rate was 100%, while physician response rate was 99.35% (457/460). Logistic regression analyzed factors influencing GPs’ COPD management, with statistical significance set at P < 0.05. Results: All 46 centers possessed complete basic equipment (blood analyzers, spirometers, X-ray, CT, ECG, pulse oximeters, oxygen therapy, and nebulizers). Part of equipment coverage varied: cardiac ultrasound (89.1%), fractional exhaled nitric oxide (FeNO) analyzers (69.6%), 6-minute walk test (6MWT) facilities (30.4%), and blood gas analyzers (6.5%). Urban centers had higher rates for cardiac ultrasound, FeNO, and 6MWT (P > 0.05). Medication Availability: Inhalers: Nebulized corticosteroids (100%), nebulized bronchodilators (95.7%), ICS + single bronchodilator (91.3%), short-acting bronchodilators (87%), long-acting bronchodilators (73.9%), triple therapy (71.7%), dual bronchodilators (23.9%). Systemic drugs: Antibiotics (100%), antitussives and expectorants (100%), TCM respiratory drugs (100%), systemic corticosteroids (82.6%), oral bronchodilators (80.4%), antivirals (65.2%), phosphodiesterase inhibitors (23.9%). No regional differences were observed (P > 0.05). Clinical Services: 43.5% (20/46) operated specialized cough-dyspnea clinics. All centers performed spirometry and bronchial dilation tests, but none offered bronchial provocation tests (P > 0.05 across regions). Physician Competency: Key knowledge gaps among 457 GPs (descending order): COPD pharmacotherapy; GOLD ABCD grouping criteria; Application of CAT/mMRC questionnaires; Identification of high-risk populations; Interpretation of pulmonary function reports. Logistic regression revealed: Physicians’ proficiency in diagnosing and staging COPD, interpreting pulmonary function tests, recognizing referral criteria, and instructing patients on inhaler use were all associated with the number of training sessions received. Conclusion: The coverage of COPD diagnostic equipment and medications at community health service centers in Pudong New Area, Shanghai, is high. However, there remain gaps in key medications, and utilization capacity is insufficient. Increasing training frequency and quality may significantly improve COPD management capabilities.