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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

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

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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

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  1. 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 WEELUMC NIJMEGEN, THE NETHERLANDS

  2. 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

  3. 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

  4. Trends1996 – 2050*1996-2050的趋势 * 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

  5. 仅“已诊断的病例” 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? 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

  6. Prevalence COPD and Asthma In practice population居民中慢阻肺和哮喘的患病率 1977 1992 (Tirimanna et al Br J Gen Pract 1996;46:277-282) professor Chris van Weel

  7. Underdiagnosis* 漏诊 实际数：有症状/体征者7% • 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 1977-1992年患病率增加 诊断不肯定 主要是轻病例(Gold 1、2期) - 早期干预效果不肯定 professor Chris van Weel

  8. 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 Determinants underdiagnosis漏诊的决定因素 professor Chris van Weel

  9. 5 years DIMCA: Gold Class & Functional StatusDIMCA5年: Gold分级及功能状况 5年后COOP-WONCA量表评分 体能 日常活动 professor Chris van Weel

  10. Coop/Wonca ChartsCOOP/WONCA量表 Physical Fitness 体能 Daily Actvities 日常活动 professor Chris van Weel

  11. professor Chris van Weel

  12. 5 years DIMCA: Gold Class & Functional StatusDIMCA5年: Gold分级及功能状况 体能 日常活动 professor Chris van Weel

  13. 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 alPrev Med, 30, 302-308 professor Chris van Weel

  14. 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 professor Chris van Weel

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