Stable Chronic Obstructive Pulmonary Disease (COPD) Management Under a Tiered Medical System in China

Abstract

Background

Early diagnosis and proper management of a large number of chronic obstructive pulmonary disease (COPD) patients are great challenges for the Chinese health care system. Although tiered medical services have been promoted by the Chinese government since 2015, they have not been ideally implemented for COPD diagnosis and management.

Patients and Methods

We designed a cross-sectional study. Eligible COPD patients (n = 648) and physicians (n = 161) were consecutively recruited from 8 hospitals in different tiers in China. COPD characteristics and treatments were compared among hospitals in different tiers. Multivariate logistic regression was performed to identify risk factors associated with airflow limitation, symptoms and acute exacerbation.

Results

The PFT rate at first diagnosis was 99%, 69.4% and 29.9% in teaching, second-tier and community hospitals (P < 0.001). Only approximately 10.9%, 1.7% and 9.6% and 21.8%, 6.9% and 32% of COPD patients received influenza or pneumococcal vaccines (P < 0.001). The proportion of patients who did not use inhaled drugs or had irregular inhalation was 2%, 24.6% and 78.8% (P < 0.001). Education level (RR-1 = −41.26%, P = 0.007), FEV1%pred (RR-1 = −2.76%, P < 0.001), and influenza vaccination in the last year (RR-1 = −64.53%, P = 0.006) were all negatively correlated with COPD acute exacerbation (AE). COPD duration (RR-1 = 131.73%, P = 0.009), AE (RR-1 = 151.39%, P < 0.001), and COPD Assessment Test (CAT) scores (RR-1 = 3.82%, P = 0.019) were all positively correlated with COPD airflow limitation severity.

Conclusion

Differences exist in the diagnosis, treatment and management of COPD among different tiers of hospitals in China. Teaching hospitals can manage COPD patients relatively well. There are still some gaps compared with developed countries.

Keywords:

• stable chronic obstructive pulmonary disease
• tiered medical system
• airflow limitation
• symptoms
• acute exacerbation

Ethics

This study was conducted in accordance with the Declaration of Helsinki.

Acknowledgments

This work was supported by National Natural Science Foundation of China (81970023 by ZH Chen), Shanghai Health Committee (201840288 by ZH Chen), National Key Research and Development Program of China, Key Special Projects of Major Chronic Non-Communicable Disease Prevention and Control (2016YFC1304600 by TY Sun), Medical Guidance Project of Shanghai Science and Technology Commission (19411969700 by L Zhu) Shanghai Top-Priority Clinical Key Disciplines Construction Project (2017ZZ02013 by ZH Chen) and Shanghai Municipal Key Clinical Specialty (shslczdzk02201 by ZH Chen).

Disclosure

The authors report no conflicts of interest in this work.