Management of acute exacerbation of chronic obstructive pulmonary disease under a tiered medical system in China
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Le résumé fourni par la source
Background: The Chinese government has promoted the ‘tiered medical services’ policy in which diseases are classified by severity, mode of onset and difficulty of treatment since 2015 to optimize medical resources. We evaluated the diagnosis and treatment of acute exacerbation (AE) of chronic obstructive pulmonary disease (AECOPD) under the tiered system. Methods: We conducted a cross-sectional study. COPD characteristics and treatments were compared among hospitals in different tiers. Associations were examined by univariate and multivariable logistic regression analysis. In addition, multivariate logistic regression was performed to identify the possible influencing factors of antibiotics, glucocorticoids and anticoagulant usages. Results: Eligible COPD patients ( n = 432) were consecutively recruited from eight hospitals in different tiers in China. Patients in the countryside preferred the community hospitals, whereas patients in cities preferred second-tier and teaching hospitals when they suffer from AECOPD. It indicates most COPD patients are likely to treat their disease locally. The severity of COPD AE increased with tiers of hospitals ( p < 0.001). However, our results clearly show that most community hospitals can only deal with mild exacerbation of COPD. Approximately 90% of AE patients received antibiotics. We speculated that antibiotics abuse might exist in the three tiers of hospitals. Multivariate analysis demonstrated that long-term antibiotics usage (≥14 days) was associated with moderate exacerbation [odds ratio (OR): 5.295, 95% confidence intervals (CI) 2.248–12.473, p < 0.001], radiographic progression (OR: 2.176, 95% CI: 1.047–4.522, p = 0.037), positive sputum etiology (OR: 3.073, 95% CI: 1.477–6.394, p = 0.003) and increased white blood cells (OR: 2.470, 95% CI: 1.190–5.126, p = 0.015). The proportion of glucocorticoids increased with the hospital hierarchy (18.6% versus 45.6% versus 69.2%, p < 0.001). The proportions of severe cases in the second-tier hospitals were 26.9%; however, non-invasive positive pressure ventilation (NPPV) rate was only 14.7%. Anticoagulant is not commonly used in AECOPD, and the community hospitals had the lowest proportion of anticoagulation regimen (1.7% versus 14.3% versus 20.5%, p = 0.002). Conclusions: The ‘tiered medical services’ policy in AECOPD management has been unsatisfactory in the past years. Irrational treatment strategies in different hospitals were still found when comparing with international guideline. Further reform of the policy is still needed to optimize the management of AECOPD in China.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Management of acute exacerbation of chronic obstructive pulmonary disease under a tiered medical system in China
- Date Crossref
- 01/02/2022
- Éditeur
- SAGE Publications
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Qingdao University Department of Respiratory and Critical Care Medicine pays non établi dans la noticeUniversité ou école supérieure
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Fudan University Department of Respiratory and Critical Care Medicine pays non établi dans la noticeUniversité ou école supérieure
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Affiliated Hospital of Qingdao University pays non établi dans la noticeÉtablissement de santé
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Zhongshan Hospital pays non établi dans la noticeÉtablissement de santé
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The First People's Hospital of Tianmen Department of Respiratory Medicine pays non établi dans la noticeÉtablissement de santé
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Punan Hospital Department of Respiratory Disease pays non établi dans la noticeÉtablissement de santé
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Soochow University Department of Respiratory and Critical Care Medicine pays non établi dans la noticeUniversité ou école supérieure
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Taixing People's Hospital pays non établi dans la noticeÉtablissement de santé
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Shanghai Zhabei District Shibei Hospital pays non établi dans la noticeÉtablissement de santé
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Beijing Hospital Department of Respiratory and Critical Care Medicine pays non établi dans la noticeÉtablissement de santé
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Shanghai Jiao Tong University pays non établi dans la noticeUniversité ou école supérieure
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Shanghai Jing’an District Zhabei Central Hospital Respiratory Medicine pays non établi dans la noticeÉtablissement de santé
Department of Respiratory and Critical Care Medicine — Qingdao University, Department of Respiratory and Critical Care Medicine — Fudan University et Affiliated Hospital of Qingdao University, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.