Page 7 - 中国全科医学2022-07

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Institute of Medical Information，Chinese Academy of Medical Sciences，Beijing 100020，China
*
Corresponding author：LI Yazi，Professor；E-mail：li.yazi@imicams.ac.cn
【Abstract】 Background China has seen a significantly increased prevalence of chronic obstructive pulmonary
disease（COPD） recently. But primary care institutions，the main "battlefield" for containing COPD，have shown relatively
weak capabilities for the diagnosis and treatment of disease. As there are relatively few large-scale investigations and studies on
medicines and diagnostic devices for COPD in primary care，we conducted this study to further understand the weaknesses of
current COPD containment in primary care，by which the gap in related research may be made up. Objective To understand the
allocation and availability rate of essential medicines for COPD，and availability rate of spirometer as well as the implementation of
pulmonary function tests in primary care. Methods From February to March 2021，a multi-stage cluster sampling was adopted
to select 8 176 community（township） health centers from 31 provinces of China to attend a survey. The rates of availability
and allocation of each of the 16 essential medicines for COPD in the 2018 National Essential Medicines List were calculated to
estimate the categories and number of these medicines in primary care institutions. The rate of availability of spirometer in these
institutions was estimated. And the rate of implementation of pulmonary function tests in these institutions was estimated. Results
Altogether，7 458（91.22%） institutions who gave effective responses to the survey were included for analysis，including
5 901（79.12%） township health centers，and 1 557（20.88%） community health centers. Among the 16 essential medicines
for COPD，less than 8 were available in 6 538（87.66%） institutions，at least 1 inhaled antiasthmatic medicines were
available in 4 992（66.00%） institutions，and long-acting inhaled antiasthmatic medicines were available in 814（10.91%）
institutions. The average availability rate of 16 essential medicines for COPD was 33.30%. The highest ranked three medicines
in terms of availability rate were ambroxol〔85.28%（6 360/7 458）〕，aminophylline〔81.17%（6 054/7 458）〕 and
compound licorice〔74.48%（5 555/7 458）〕. And the relatively low-ranked three were fluticasone propionate 〔4.89%（365
/7 458）〕，tiotropium bromide〔6.25%（466/7 458）〕，budesonide forterol〔8.61%（642/7 458）〕. The average
availability rate of 6 inhaled antiasthmatic medicines in community health centers was 28.31%，and that in township health centers
was 4.81%. The average availability rate of 2 long-acting inhaled antiasthmatic medicines in community health centers was 16.18%，
and that in township health centers was 5.12%. The average availability rate of spirometers in primary care institutions was 8.94%
（667/7 458）. The average availability rate of spirometers in community health centers was higher than that of township health
centers〔18.56%（289/1 557）vs 6.41%（378/5 901），P<0.05〕. Pulmonary function tests were implemented in 10.82%
（807/7 458） of the institutions. The rate of community health centers was higher than that of township health centers in terms
of offering pulmonary function testing services〔13.81%（215/1 557） vs 10.03%（592/5 901），P<0.05〕. Conclusion
The available essential medicines for COPD in these primary care institutions were insufficient with unbalanced distribution.
Most of available medicines were oral preparations，and inhaled antiasthmatic medicines，especially long-acting inhaled
antiasthmatic medicines，were poorly available. Moreover，the availability rate of spirometers and the implementation rate of
pulmonary function tests were both relatively low. All these factors negatively influence early screening for and management of
COPD in primary care. In view of this，it is recommended that increasing the availability levels of inhaled antiasthmatic medicines
and portable spirometers，and the application of pulmonary function tests in primary care，as well as primary care physicians
asompetencies and initiatives for the prevention，diagnosis，treatment and rehabilitation of COPD with the delivery of the national
essential publish health services for COPD as the starting point of enhancement trainings.
【Key words】 Pulmonary disease，chronic obstructive；Delivery of health care；Primary health care institution；
Drugs，essential；Diagnostic services；Diagnostic equipment

以慢性阻塞性肺疾病（COPD）为代表的慢性呼 会认知、诊疗能力、资源配置、卫生政策等，使得
吸系统疾病是常见四大慢性病之一。近年来，我国 COPD 防控成为慢性病防控中的“短板”，并发展为
COPD 患病率明显升高，40 岁及以上人群患病率由 我国重要的公共卫生问题，严重影响居民的身体健
2002—2004 年的 8.2% 上升至 2015 年的 13.7%。据 康和生活质量 ［3］ 。乡镇卫生院和社区卫生服务中心
估计我国约有 1 亿例 COPD 患者 ［1-2］ ，COPD 已成为 作为农村和城市基层医疗卫生服务体系的重要基础，
仅次于高血压、糖尿病的第三大常见慢性病和第三位 承担着常见病和多发病的诊疗、基本公共卫生服务
主要死因。COPD 具有高患病率、高致残率、高死亡 等任务，也是 COPD 患者的首诊机构和疾病管理“主
率、高经济负担等特点，且长期以来 COPD 在防控体 战场” ［3-5］ ，在 COPD 高危人群筛查、早期诊断、
系和能力建设方面落后于高血压和糖尿病，包括社 随访管理、康复治疗、戒烟干预等方面发挥着重要