professorChrisvanWeel,THESILENTEPIDEMICofCOPD:HOWITHITSFAMILYPRACTICE潜在流行性慢阻肺对家庭医生的困扰,PROF.CHRISVANWEELUMCNIJMEGEN,THENETHERLANDS,professorChrisvanWeel,Epidemiology:流行病学frompopulationtopractice从居民到医生,COPDastheexample-study慢阻肺作为研究范例Practicelevel:individualadviceandtherapyRoleoffamilyphysician家庭医生的作用Organizeindividualcare,populationperspective对居民有组织的个体化照顾DatafromtheNetherlands荷兰的数据EncouragementtopursueChinesedataCriticalforleadership,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,professorChrisvanWeel,COPDInfamilypractice家庭医疗中的慢阻肺,Incidence*发病率23/1,000Prevalentie*患病率22/1,000Averagefamilypractice:每个家庭医生平均患者55undertreatment治疗中6-7newcasesyearly每年新病例*DataContinousMorbidityRegistration,DepartmentofFamilyMedicine,Nijmegen根据家庭医学部持续登记的患病率,professorChrisvanWeel,Trends19962050*1996-2050的趋势,*DataContinuousMorbidityRegistration,DepartmentofFamilyPractice,Nijmegen根据家庭医学部持续登记的患病率,professorChrisvanWeel,(TirimannaetalBrJGenPract1996;46:277-282),professorChrisvanWeel,Underdiagnosis*漏诊,Substantial:7%populationsigns/symptomsIncreasedprevalence1977-1992Diagnosticuncertaintymainlymilddisease(Goldstages1,2)Effectivenessearlyinterventionunclear*TirimannaetalBrJGenPract1996;46:277-282,实际数：有症状/体征者7%,1977-1992年患病率增加,诊断不肯定,早期干预效果不肯定,主要是轻病例(Gold1、2期)-,professorChrisvanWeel,Determinantsunderdiagnosis漏诊的决定因素,PHYSICIAN医生方面Knowledge知识Skills技能Implications暗示expectation:期望值：label/stigma标记/担心smokingcessation戒烟,PATIENT病人方面toleratesymptoms能忍受dislikemedication不想吃药anxietystigma焦虑担心knowFPadvice:知道医生要劝：smokingcessation戒烟,professorChrisvanWeel,5yearsDIMCA:GoldClass&FunctionalStatusDIMCA5年:Gold分级及功能状况,5年后COOP-WONCA量表评分,体能日常活动,professorChrisvanWeel,Coop/WoncaChartsCOOP/WONCA量表,DailyActvities日常活动,PhysicalFitness体能,professorChrisvanWeel,professorChrisvanWeel,5yearsDIMCA:GoldClass&FunctionalStatusDIMCA5年:Gold分级及功能状况,体能日常活动,professorChrisvanWeel,EffectivenessEarlyIntervention(DIMCA)早期干预的作用,Earlytreatment*:早期治疗：Improvesqualityoflife&functioning改善生活质量及功能Reducesexacerbations减少恶化Noeffectlungfunctiondecline肺功能减低无作用Noeffectmildpersistentsymptoms轻度持续性症状无作用Nocaseforscreening无供筛查病例Noalternativeprimaryprevention:smoking,openfirescessation无可替代的一级预防：戒烟和明火,*vandenboometalPrevMed,30,302-308,professorChrisvanWeel,Conclusion结论,COPDimportantproblempracticepopulation慢阻肺是居民中的重要问题Diagnosisandtreatment诊断和治疗Makeadifference区别对待ButsmokingcessationKeytosuccess戒烟是胜利的关键Familymedicineleadership家庭医学主导addresspopulationneeds致力于公众需求prioritytowhatcounts优先解决遇到的问题,