Investigation Of The Implementation Of The Guideline For Diagnosis, Management Of Chronic Obstructive Pulmonary Disease In Hunan Province

Objective: The objective of the research is to investigate the implementation of the guideline for diagnosis, management of chronic obstructive pulmonary disease in Hunan province, and to find possible unfavorable factors in the implementation of the guideline, and then explore the related solutions.Methods: The questionnaires were self-designed according to the contents of the guideline. After designing the questionnaires, we randomly selected 48 hospitals of different grade in Hunan province. All the hospitals and doctors were divided into three groups by the grade of the hospitals. We planned to organize the physicians who directly involved in diagnosis and management of respiratory disease in the taking hospitals above-mentioned to participate in the survey, the participants were asked to finish their questionnaires time-limited, anonymous, and closed-book, also they were told that the results of examination would not be anounced. The doctors' questionnaires were divided into groups by three means. And then we compared the universal rates of the instruments for diagnosis and management of COPD in the taking hospitals rankly, summaried the scores and correct rates of the doctors' questionnaires, and then analyzed the data statistically by using the SPSS 16.0 software.Results: (1) The universal rate of lung function test in all hospitals was 47.92%, and in hospitals of grade 3 was 100.00%, in hospitals of grade 2 was 33.34%, in hospitals of grade 1 was 0.00%. (2) The universal rate of inhaled agents in all hospitals was 68.75%, and in hospitals of grade 3 was 100.00%, in hospitals of grade 2 was 70.85%, in hospitals of grade 1 was 11.12%. (3) The universal rate of health education lecture in all hospitals was 41.67%, and in hospitals of grade 3 was 66.67%, in hospitals of grade 2 was 41.67%, in hospitals of grade 1 was 0.00%. (4) We have handed out 839 doctors' questionnaires, and there were 814 questionnaires handed in. Besides, there were 21 unqualified questionnaires excluded. (5) The P₂₅, P₅₀, P₇₅ of the scores of all doctors were 60, 80, 90, and P₂₅, P₅₀, P₇₅ of the scores of doctors in hospitals of grade 3 were 80 90, 100, in hospitals of grade 2 were 60, 80, 90, in hospitals of grade 1 were 10, 25, 40. (6) In the hospitals of grade 3, the correct rates of each topic were listed below from the 1^st to 10^th topic: 99.48%, 68.23%, 98.44%, 100.00%, 91.15%, 83.85%, 88.02%, 97.92%, 86.98%, 86.98%; and in the hospitals of grade 2 they were 76.57%, 54.03%, 78.53%, 83.18%, 61.72%, 74.96%, 57.42%, 67.26%, 84.97%, 65.47%; in the hospitals of grade 1 they were 4.76%, 71.43%, 19.05%, 66.67%, 4.76%, 14.29%, 0.00%, 0.00%, 64.29%, 11.90%. (7) There were 192 respiratory physicians in the hospitals of grade 3, including 73 high-educated doctors, 117 middle-educated doctors, and 2 low-educated doctors; there were 559 respiratory physicians in the hospitals of grade 2, including 9 high-educated doctors, 424 middle-educated doctors, and 126 low-educated doctors; there were 42 respiratory physicians in the hospitals of grade 1, including 24 middle-educated doctors, and 18 low-educated doctors. And we found that the proportion of high-educated doctors in hospitals of grade 3 is higher than other hospitals, and the proportion of low-educated doctors reduced while the grade of the hospital increased. (8) The scores of doctors' questionnaires were higher while the doctors' academic qualifications were higher.Conclusions: (1) The universal rates of lung function test and inhaled agents of hospitals of grade 3 were higher than other hospitals. (2) All the doctors didn't pay enough attention to the health education lecture, especially the doctors in hospitals of grade 1. (3) Doctors who worked in the hospital of higher grade had a better grasp of COPD knowledge. (4) The proportion of high-educated doctors in hospitals of grade 3 was higher than other hospitals, and the proportion of low-educated doctors reduced while the grade of the hospital increased.