Follow-up study on management of chronic obstructive pulmonary disease in Hunan Province, the People's Republic of China.
BACKGROUND
In 2009, our study showed an extreme imbalance and disparity in COPD-related health resources allocation at three levels of public hospitals (PHs) in Hunan Province of the People's Republic of China, especially in second-level PHs. Moreover, most Chinese citizens accept their health care services in first- and second-level PHs for economic and geographical reasons, as well as because of the incomplete transfer system in the health care services. To improve diagnosis and treatment ability of pulmonologists in second-level PHs, an intervention that provided training combined with spirometry equipment was carried out in three PHs from six second-level PHs. The aim of this follow-up study was to evaluate the changes associated with COPD-related health resources allocation and the effect of the intervention 4 years later.


METHODS
The data regarding the availability of spirometers, inhalation agents for COPD, and COPD-related health care education for local residents were collected from 57 PHs in 2009 and 48 PHs in 2013. Pulmonologists working in these PHs were asked to complete a questionnaire individually. Six second-level PHs (three in the intervention group and the other three in the control group [without training and spirometry equipment]) that further took part in the survey in 2009 were reevaluated to determine the doubtful diagnostic ratio and the confirmation ratio of COPD. The differences between 2009 and 2013 data was analyzed.


RESULTS
A total of 762 questionnaires were completed. Compared with 2009, spirometer-equipped ratio raised from 40% to 69% in 2013 (P=0.03). The overall inhalation agent-equipped ratio increased from 58% in 2009 to 88% in 2013 (P=0.001). The total rate of health education raised from 35% in 2009 to 63% in 2013 (P=0.04). In total, 204 pulmonologists from six PHs (selected for study in 2009) completed the questionnaires in 2013. The median score of COPD knowledge questionnaire in the intervention group was higher than that of the control group (80 vs 50, respectively, P<0.01). Further, the clinical doubtful diagnostic ratio (15%) and the diagnosis ratio of COPD (3%) in the intervention group were higher than in the control group (4% and 1%, respectively, P<0.05) even after 4 years.


CONCLUSIONS
COPD-related health resources allocation improved in the 4 years following intervention at three levels of PHs in the People's Republic of China. Short-term training combined with spirometry equipment had a sustained effect on improving the physicians' understanding and diagnosis ability of COPD.
Department of Respiratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
Yuqin
Y
Zeng
Department of Respiratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
Jianxian
J
Xu
Department of Respiratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
Shan
S
Cai
Department of Respiratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
Fen
F
Jiang
Department of Respiratory Medicine, Shenzhen City Baoan District Central Hospital, Shenzhen, Guangdong, People's Republic of China.
Anmei
A
Hu
Department of Respiratory Medicine, The Yueyang First People's Hospital, Yueyang, Hunan, People's Republic of China.
Huayun
H
Liu
Department of Respiratory Medicine, Changsha Central Hospital, Changsha, People's Republic of China.
Chengli
C
Bei
Department of Respiratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
Ping
P
Chen
D002681:China; D003430:Cross-Sectional Studies; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006295:Health Resources / Q000600:supply & distribution*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D013997:Time Factors
COPD; China; public hospitals; pulmonologists; training