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THE SILENT EPIDEMIC of COPD: HOW IT HITS FAMILY PRACTICE 潜在流行性慢阻肺对家庭医生的困扰. PROF. CHRIS VAN WEEL UMC NIJMEGEN, THE NETHERLANDS. Epidemiology: 流行病学 from population to practice 从居民到医生. COPD as the example-study 慢阻肺作为研究范例 Practice level: individual advice and therapy - PowerPoint PPT Presentation
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THE SILENT EPIDEMIC of COPD: HOW IT HITS FAMILY PRACTICE
潜在流行性慢阻肺对家庭医生的困扰PROF. CHRIS VAN WEEL
UMC NIJMEGEN, THE NETHERLANDS
professor Chris van Weel
Epidemiology: 流行病学 from population to practice
从居民到医生• COPD as the example-study 慢阻肺作为研究范例• Practice level: individual advice and therapy• Role of family physician 家庭医生的作用
– Organize individual care, population perspective
对居民有组织的个体化照顾• Data from the Netherlands 荷兰的数据
– Encouragement to pursue Chinese data
– Critical for leadership
实际水平:个体化指导和治疗
对中国人的追踪研究数据
对领导工作的评价
professor Chris van Weel
COPDIn family practice家庭医疗中的慢阻肺
• Incidence* 发病率 2 – 3 / 1,000 • Prevalentie* 患病率 22 / 1,000• ‘Average’ family practice: 每个家庭医生平均患者
– 55 under treatment 治疗中– 6 - 7 new cases yearly 每年新病例* Data Continous Morbidity Registration, Department of Family Medicine, Nijmegen
根据家庭医学部持续登记的患病率
professor Chris van Weel
Trends1996 – 2050*1996-2050 的趋势
010
2030
405060
7080
90100
1996 2020 2035 2050
HFcataractCOPD
* Data Continuous Morbidity Registration, Department of Family Practice,
Nijmegen 根据家庭医学部持续登记的患病率
professor Chris van Weel
Only ‘diagnosed cases’
• Dimca Study: undiagnosed COPD
• 10 Family practices Nijmegen, 1992
• Questionnaires and spirometry
• 1159 adults without known COPD, asthma
• How to make a difference?
仅“已诊断的病例”
漏诊的慢阻肺
1992 年 10 个家庭医生的材料
问卷调查及肺活量测定
1159 例没有已知慢阻肺和哮喘的成年人
如何鉴别?
professor Chris van Weel
1977 1992
Prevalence COPD and AsthmaIn practice population 居民中慢阻肺和哮喘的患病率
(Tirimanna et al Br J Gen Pract 1996;46:277-282)
professor Chris van Weel
Underdiagnosis* 漏诊
• Substantial: 7% population signs/symptoms
• Increased prevalence 1977 - 1992
• Diagnostic uncertainty
– mainly mild disease (Gold stages 1, 2)
• Effectiveness early intervention unclear
* Tirimanna et al Br J Gen Pract 1996;46:277-282
实际数:有症状 / 体征者 7%1977-1992 年患病率增加
诊断不肯定
早期干预效果不肯定
主要是轻病例(Gold 1 、 2 期 )-
professor Chris van Weel
Determinants underdiagnosis漏诊的决定因素
• PHYSICIAN 医生方面
– Knowledge 知识– Skills 技能– Implications 暗示– expectation: 期望值:
• label/stigma 标记 / 担心• smoking cessation 戒烟
• PATIENT 病人方面
– tolerate symptoms 能忍受– dislike medication 不想吃药– anxiety stigma 焦虑担心– ‘know’ FP advice: 知道医生要劝:
• smoking cessation 戒烟
professor Chris van Weel
5 years DIMCA: Gold Class & Functional Status
DIMCA5 年 : Gold 分级及功能状况COOP-WONCA scores after 5 years
T=0
Physical
fitness
95% CI Daily
activities
95% CI
Not classified 2.29 2.17-2.41 1.67 1.56-1.78
GOLD 0 2.50 2.06-2.94 1.93 1.31-2.55
GOLD 1 2.07 1.54-2.60 1.07 0.92-1.23
GOLD 2 2.85 2.20-3.49 2.38 1.58-3.19
5 年后 COOP-WONCA 量表评分
体能 日常活动
professor Chris van Weel
Coop/Wonca ChartsCOOP/WONCA 量表
Daily Actvities 日常活动Physical Fitness 体能
professor Chris van Weel
professor Chris van Weel
5 years DIMCA: Gold Class & Functional Status
DIMCA5 年 : Gold 分级及功能状况COOP-WONCA scores after 5 years
T=0
Physical
fitness
95% CI Daily
activities
95% CI
Not classified 2.29 2.17-2.41 1.67 1.56-1.78
GOLD 0 2.50 2.06-2.94 1.93 1.31-2.55
GOLD 1 2.07 1.54-2.60 1.07 0.92-1.23
GOLD 2 2.85 2.20-3.49 2.38 1.58-3.19
体能 日常活动
professor Chris van Weel
Effectiveness Early Intervention (DIMCA) 早期干预的作用
• Early treatment*: 早期治疗:– Improves quality of life & functioning 改善生活质量及功能– Reduces exacerbations 减少恶化– No effect lungfunction decline 肺功能减低无作用
No effect mild persistent symptoms 轻度持续性症状无作用• No case for screening 无供筛查病例 • No alternative primary prevention: smoking, open fires
cessation 无可替代的一级预防:戒烟和明火* van den boom et al Prev Med, 30, 302-308
professor Chris van Weel
Conclusion 结论• COPD important problem practice population
慢阻肺是居民中的重要问题• Diagnosis and treatment 诊断和治疗
– Make a difference 区别对待• But smoking cessation
——Key to success 戒烟是胜利的关键 • Family medicine leadership 家庭医学主导
– address population needs 致力于公众需求– priority to what counts 优先解决遇到的问题