上海市某社区医务人员慢性阻塞性肺疾病长期家庭氧疗业务能力及影响因素研究

韦莉君; 余峰; 石建伟; 傅华

doi:10.16766/j.cnki.issn.1674-4152.002508

上海市某社区医务人员慢性阻塞性肺疾病长期家庭氧疗业务能力及影响因素研究

doi: 10.16766/j.cnki.issn.1674-4152.002508

韦莉君¹,
余峰^1, ,,
石建伟²,
傅华³

1.
上海市闵行区七宝社区卫生服务中心, 上海 201101
2.
上海交通大学医学院, 上海 200025
3.
复旦大学上海医学院, 上海 200032

基金项目:

国家自然科学基金青年基金项目 71503182

上海市闵行区自然科学研究课题 2019MHZ070

详细信息

通讯作者:
余峰，E-mail：18017106556@189.com

中图分类号: R197.61 R563 R459.6
计量
- 文章访问数: 288
- HTML全文浏览量: 119
- PDF下载量: 8
- 被引次数: 0
出版历程
- 收稿日期: 2021-10-08
- 网络出版日期: 2022-09-21

Professional ability and influencing factors of COPD family long-term oxygen therapy of community medical staff in one community healthcare centre in Shanghai

WEI Li-jun¹,
FU Hua^{1
, ,},
SHI Jian-wei²,
FU Hua³

1.
Department of General Practice, Qibao Community Health Service Center, Shanghai 201101, China

摘要

摘要: 目的探讨社区医务人员长期家庭氧疗(LTDOT)的业务能力及影响因素, 为慢性阻塞性肺疾病(COPD)家庭氧疗的社区管理和应用提供理论依据。方法于2020年5-11月, 对上海某社区卫生服务中心医务人员开展调查。采用χ²检验、logistic回归分析社区医务人员COPD家庭氧疗业务能力现况及影响因素。结果社区医务人员家庭氧疗专业知识及格率为73.60%。对不同岗位在各题项的合格率差异分析显示, 社区不同岗位医务人员在COPD患者家庭氧疗作用、原则、氧流量浓度及控制范围、高浓度氧气吸入对COPD患者的影响、COPD患者每日吸氧时间和判断氧疗效果指标6个题项上差异有统计学意义(均P < 0.05)。Logistic回归分析显示女性家庭氧疗专业能力明显高于男性(OR=3.300, P=0.003), 公共卫生(OR=0.250, P=0.009)、医技人员(OR=0.103, P < 0.001)的专业知识普遍弱于临床医生, 50~59岁组(OR=0.179, P=0.005)家庭氧疗专业能力明显低于年轻组。结论社区医务人员COPD长期家庭氧疗专业能力存在一定短板, 特别是对部分特征医务人员, 应通过多渠道和多方式提升社区医务人员COPD长期家庭氧疗的应用和管理能力。
- 社区医务人员 /
- 长期家庭氧疗 /
- 影响因素
Abstract: Objective To explore the professional ability and influencing factors of family long-term domiciliary oxygen therapy of community medical staff, so as to provide theoretical basis for the community management and application of family oxygen therapy for chronic obstructive pulmonary disease (COPD). Methods A comprehensive questionnaire survey was conducted amongst the medical staff of one community health service centre in Shanghai from May to November 2020.The χ² test and logistic regression were used to analyse the status and influencing factors of family oxygen therapy professional ability of community medical staff. Results The pass rate of family oxygen therapy professional knowledge of community medical staff was 73.60%.Analysis of the qualified rate in each item showed that there were significant differences amongst six items, including the function, principle, oxygen flow concentration and control range, high concentration of oxygen inhalation on COPD patients, daily oxygen inhalation time and judgment of oxygen therapy effect index (all P < 0.05).In total, the number of females was significantly higher than that of males (OR=3.300, P=0.003).The professional knowledge of public health (OR=0.250, P=0.009) and medical technicians (OR=0.103, P < 0.001) was generally weaker than that of clinicians.The 50-59 years old group (OR=0.179, P=0.005) was significantly lower than the young group. Conclusion There are some shortcomings in the professional ability of community medical staff in COPD long-term family oxygen therapy, especially for some medical staff with special characteristic.The application and management ability of community medical staff in COPD long-term family oxygen therapy should be improved through multiple channels and ways.
- Community medical staff /
- Long-term domiciliary oxygen therapy /
- Influencing factors

HTML全文

表 1 303名社区医务人员的基本特征分布

Table 1. Demographics of 303 community medical staffs

项目	类别	人数(%)	项目	类别	人数(%)
性别	男性	49(16.17)	学历	高中	4(1.32)
	女性	254(83.83)		大专	75(24.75)
年龄(岁)	20~29	38(12.54)		本科	210(69.31)
	30~39	134(44.22)		硕士及以上	14(4.62)
	40~49	95(31.35)	职称	初级	117(38.61)
	50~59	36(11.88)		中级	172(56.77)
岗位	临床医生	100(33.00)		高级	14(4.62)
	公共卫生	23(7.59)	是否关注指南	是	111(36.63)
	护士	119(39.27)		否	192(63.37)
	医技	46(15.18)
	其他	15(4.95)

下载: 导出CSV

表 2 不同特征社区医务人员长期家庭氧疗知识及格率比较[人(%)]

Table 2. Comparison of passing rate of long-term family oxygen therapy knowledge among community medical personnel with different characteristics [cases (%)]

项目	不及格(n=80)	及格(n=223)	χ²值	P值
性别			12.686	< 0.001
男性	23(28.75)	26(11.66)
女性	57(71.25)	197(88.34)
年龄(岁)			8.194	0.042
20~29	7(18.42)	31(81.58)
30~39	36(26.87)	98(73.13)
40~49	21(22.11)	74(77.89)
50~59	16(44.44)	20(55.56)
岗位			40.666	< 0.001
临床医生	20(25.00)	80(35.87)
公共卫生	10(12.50)	13(5.83)
护士	17(21.25)	102(45.74)
医技	27(33.75)	19(8.52)
其他	6(7.50)	9(4.04)
是否关注指南			6.874	0.009
是	39(48.75)	72(32.29)
否	41(51.25)	151(67.71)
总体合格情况	80(26.40)	223(73.60)
注：本表格仅保留P < 0.05的分类结果。

下载: 导出CSV

表 3 不同岗位医务人员各项COPD家庭氧疗专业知识正确率比较[人(%)]

Table 3. Comparison of accuracy rate of various COPD family oxygen therapy professional knowledge of medical staff in different positions [cases (%)]

条目	合计	临床医生	公共卫生	护士	医技	其他	χ²值	P值
1	229(75.58)	82(82.00)	15(65.22)	92(77.31)	27(58.70)	13(86.67)	11.868	0.018
2	193(63.70)	71(71.00)	10(43.48)	92(77.31)	14(30.43)	6(40.00)	41.562	< 0.001
3	215(70.96)	72(72.00)	17(73.91)	94(78.99)	31(67.39)	11(73.33)	2.804	0.591
4	175(57.76)	60(60.00)	12(52.17)	76(63.87)	18(39.13)	9(60.00)	8.892	0.064
5	178(58.75)	59(59.00)	13(56.52)	83(69.75)	15(32.61)	8(53.33)	19.141	0.001
6	197(65.02)	60(60.00)	14(60.87)	99(83.19)	16(34.78)	8(53.33)	37.953	< 0.001
7	222(73.27)	75(75.00)	18(78.26)	97(81.51)	25(54.35)	7(46.67)	18.402	0.001
8	70(23.10)	20(20.00)	3(13.04)	39(32.77)	3(6.52)	5(33.33)	16.119	0.003
9	184(60.73)	93(93.00)	22(95.65)	113(94.96)	41(89.13)	15(100.00)	3.200	0.525
10	264(87.13)	84(84.00)	17(73.91)	111(93.28)	39(84.78)	13(86.67)	8.695	0.069
注：条目序号指代意义如下，1为COPD患者LTDOT的作用；2为COPD患者LTDOT的原则；3为LTDOT的应用指征；4为COPD患者LTDOT的频率；5为COPD患者LTDOT的浓度；6为COPD患者LTDOT的氧流量控制范围对控制病情影响；7为长期吸入高浓度氧气对COPD患者的影响；8为COPD患者LTDOT的每日吸氧时间；9为COPD患者LTDOT期间不能从事的活动；10为氧疗效果的指标。

下载: 导出CSV

表 4 社区医务人员家庭长程氧疗专业能力回归分析

Table 4. Regression analysis of family long-term oxygen therapy professional ability of community medical staff

项目	B	SE	Wald χ²	P值	OR值	95% CI
女性	1.194	0.402	8.819	0.003	3.300	1.501~7.257
年龄(岁)
30~39	-0.856	0.528	2.631	0.105	0.425	0.151~1.195
40~49	-0.650	0.559	1.353	0.245	0.522	0.175~1.561
50~59	-1.723	0.620	7.726	0.005	0.179	0.053~0.602
岗位
公共卫生	-1.386	0.532	6.774	0.009	0.250	0.088~0.710
护士	-0.179	0.433	0.170	0.680	0.836	0.358~1.954
医技	-2.276	0.456	24.945	< 0.001	0.103	0.042~0.251
其他	-1.173	0.626	3.505	0.061	0.309	0.091~1.057
注：变量赋值方法如下，因变量为合格与否: 合格=1, 不合格=0；自变量中，性别：男性=0，女性=1；年龄：20~29岁=0，30~39岁=1，40~49岁=2，50~59岁=3；岗位：临床医生=0，公共卫生=1，护士=2，医技=3，其他=4。因变量和自变量的哑变量设置中，以0组为参照组。

下载: 导出CSV

参考文献(16)

[1]	李雪儿, 杨雪凝, SANDRA A, 等. 慢性阻塞性肺疾病患者长期家庭氧疗的最佳证据总结[J]. 护理学杂志, 2021, 36(3): 42-46. doi: 10.3870/j.issn.1001-4152.2021.03.042 LI X R, YANG X N, SANDRA A, et al. Summary of the best evidence for long-term home oxygen therapy in patients with chronic obstructive pulmonary disease[J]. Journal of Nursing Science, 2021, 36(3): 42-46. doi: 10.3870/j.issn.1001-4152.2021.03.042
[2]	王辰, 迟春花, 陈荣昌, 等. 慢性阻塞性肺疾病基层诊疗指南(2018年)[J]. 中华全科医师杂志, 2018, 17(11): 856-870. doi: 10.3760/cma.j.issn.1671-7368.2018.11.002 WANG C, CHI C H, CHEN R C, et al. Guidelines for primary care of chronic obstructive pulmonary disease (2018) [J]. Chinese Journal of General Practitioners, 2018, 17(11): 856-870. doi: 10.3760/cma.j.issn.1671-7368.2018.11.002
[3]	王桂芳. 慢性阻塞性肺疾病患者长期家庭氧疗现状调查与分析[J]. 医药前沿, 2018, 8(19): 380-382. doi: 10.3969/j.issn.2095-1752.2018.19.332 WANG G F. Investigation and analysis of the current status of long-term home oxygen therapy in patients with chronic obstructive pulmonary disease[J]. Medical Frontiers, 2018, 8(19): 380-382. doi: 10.3969/j.issn.2095-1752.2018.19.332
[4]	王永滨, 汤莺, 张晓兰, 等. 夜间低氧对慢性阻塞性肺疾病患者血清IL-6、IL-8的影响[J]. 中国临床医学, 2019, 26(6): 905-908. https://www.cnki.com.cn/Article/CJFDTOTAL-LCYX201906024.htm WANG Y B, TANG Y, ZHANG X L, et al. Effects of nocturnal hypoxia on serum IL-6 and IL-8 in patients with chronic obstructive pulmonary disease[J]. Chinese Journal of Clinical Medicine, 2019, 26(6): 905-908. https://www.cnki.com.cn/Article/CJFDTOTAL-LCYX201906024.htm
[5]	陈浩波. COPD缓解期并慢性Ⅱ型呼吸衰竭长期家庭氧疗临床观察[J]. 中国基层医药, 2002, 9(6): 15-16. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJCY200206009.htm CHEN H B. Clinical observation of long-term home oxygen therapy in COPD remission and chronic type Ⅱ respiratory failure[J]. Chinese Journal of Primary Medicine and Pharmacy, 2002, 9(6): 15-16. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJCY200206009.htm
[6]	陆竹仙, 尹丽华. 慢性阻塞性肺疾病患者疾病预防控制现状及疾病管理模式研究进展[J]. 中西医结合护理(中英文), 2019, 5(11): 148-150. doi: 10.11997/nitcwm.2019011046 LU X Z, YIN L H. Research progress on the status quo of disease prevention and control and disease management mode in patients with chronic obstructive pulmonary disease[J]. Nursing of Integrated Traditional Chinese and Western Medicine, 2019, 5(11): 148-150. doi: 10.11997/nitcwm.2019011046
[7]	孙素玲. 慢性阻塞性肺病患者长期家庭氧疗的依从性现状及其影响因素的研究进展[J]. 中国医疗管理科学, 2017, 7(1): 58-62. doi: 10.3969/j.issn.2095-7432.2017.01.013 SUN S L. Research progress on the status of long-term adherence to home oxygen therapy in patients with chronic obstructive pulmonary disease and its influencing factors[J]. Chinese Journal of Medical Management Sciences, 2017, 7(1): 58-62. doi: 10.3969/j.issn.2095-7432.2017.01.013
[8]	邵惠弟, 罗解萍. 基于居家氧疗与康复训练现状评估的层级延续护理在慢性阻塞性肺疾病老年患者中的应用[J]. 全科医学临床与教育, 2021, 19(11): 1051-1053. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYL202111032.htm SHAO H D, LUO J P. Application of hierarchical continuing care based on assessment of the current status of home oxygen therapy and rehabilitation training in elderly patients with chronic obstructive pulmonary disease[J]. Clinical Education of General Practice, 2021, 19(11): 1051-1053. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYL202111032.htm
[9]	钱琼, 谭莉, 方思, 等. 慢性阻塞性肺疾病患者疾病感知与自我管理和生活质量的相关性[J]. 中国临床研究, 2019, 32(11): 1492-1495. QIAN Q, TAN L, FANG S, et al. Correlation of disease perception with self-management and quality of life in patients with chronic obstructive pulmonary disease[J]. Chinese Journal of Clinical Research, 2019, 32(11): 1492-1495.
[10]	刘德营, 李俊. 社区长期家庭氧疗治疗慢性阻塞性肺疾病疗效研究[J]. 中国社区医师, 2020, 36(22): 49-50. doi: 10.3969/j.issn.1007-614x.2020.22.023 LIU D Y, LI J. A study on the efficacy of long-term home oxygen therapy in the community in the treatment of chronic obstructive pulmonary disease[J]. Chinese Community Doctors, 2020, 36(22): 49-50. doi: 10.3969/j.issn.1007-614x.2020.22.023
[11]	吴诗诗, 刘宇, 杨开连, 等. 基于患者社会网络的干预对COPD自我管理等影响的系统评价[J]. 中华全科医学, 2020, 18(11): 1940-1945. doi: 10.16766/j.cnki.issn.1674-4152.001659 WU S S, LIU Y, YANG K L, et al. Effect of social network-based interventions on self-management and others of patients with chronic obstructive pulmonary disease: A systematic review[J]. Chinese General Practice, 2020, 18(11): 1940-1945. doi: 10.16766/j.cnki.issn.1674-4152.001659
[12]	袁月荣, 孙灵英, 蒋长征, 等. 基层医务人员流感疫苗接种知信行调查[J]. 预防医学, 2017, 29(11): 1170-1173. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYFX201912008.htm YUAN Y R, SUN L Y, JIANG C Z, et al. Investigation of influenza vaccination of grass-roots medical personnel[J]. Preventive Medicine, 2017, 29(11): 1170-1173. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYFX201912008.htm
[13]	史燕, 方英, 李云娜, 等. 慢性阻塞性肺疾病合并肺部真菌感染的危险因素分析及护理对策[J]. 中华全科医学, 2018, 16(2): 309-312. doi: 10.16766/j.cnki.issn.1674-4152.000086 SHI Y, FANG Y, LI Y N, et al. Risk factors analysis and nursing strategies of COPD patients with pulmonary fungal infection[J]. Chinese General Practice, 2018, 16(2): 309-312. doi: 10.16766/j.cnki.issn.1674-4152.000086
[14]	蒋维芃, 宋元林. 家庭无创正压通气治疗稳定期慢性阻塞性肺疾病: 现状与展望[J]. 北京医学, 2020, 42(12): 1278-1280. https://www.cnki.com.cn/Article/CJFDTOTAL-BJYX202012034.htm JIANG W P, SONG Y L. Family noninvasive positive pressure ventilation in the treatment of stable chronic obstructive pulmonary disease: Current situation and prospects[J]. Beijing Medical Journal, 2020, 42(12): 1278-1280. https://www.cnki.com.cn/Article/CJFDTOTAL-BJYX202012034.htm
[15]	李凡, 孙惠芬, 段静, 等. 从GOLD指南的演变看慢性阻塞性肺疾病的防治[J]. 中国全科医学, 2019, 22(27): 3275-3280. doi: 10.12114/j.issn.1007-9572.2019.00.383 LI F, SUN H F, DUAN J, et al. Prevention and treatment of chronic obstructive pulmonary disease from the evolution of GOLD[J]. Chinese General Practice, 2019, 22(27): 3275-3280. doi: 10.12114/j.issn.1007-9572.2019.00.383
[16]	王家艳. 加强慢性阻塞性肺疾病的社区管理对提高患者生活质量的影响——评《慢性阻塞性肺疾病社区管理规范手册》[J]. 中国实验方剂学杂志, 2021, 27(21): 197. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSFX202121028.htm WANG J Y. The Impact of strengthening community management of chronic obstructive pulmonary disease on improving patients ' quality of life: Review of the manual of community management norms for chronic obstructive pulmonary disease[J]. Chinese Journal of Experimental Traditional Medical Formulae, 2021, 27(21): 197. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSFX202121028.htm