| Abstract |
Background
According to the World Health Organization (WHO) it is estimated that 65 million
people have moderate to severe COPD and that more than 3 million people died of
COPD in 2005, a frequency corresponding to 5 % of global deaths. The need for
spirometry to diagnose COPD is given of guidelines, including those created for the
needs of Primary Health Care (PHC). However, few General Practitioners have access
to spirometry or systematically use spirometry in daily clinical practice. Moreover,
taking into account the cultural determinants on health habits of the population of our
country, it was found that in Greece smoking habit, holds one of the highest level in
Europe and the lifelong impact of COPD in people aged> 35 years with a history of
smoking > 100 cigarettes is estimated at 8.4 %
Aim
The aim of this thesis was to investigate the level of knowledge, related to COPD, in
GPs from rural and remote areas of Crete and how could affect, in this, an intensive
training program focused on their self reported needs. This thesis also intends to
investigate how feasible educational initiatives aiming at influencing the quality of
life of patients with COPD, are as well the attitude of smokers towards smoking habit.
Finally, based on personal experience and with the help of literature review, taking
into account the cultural and geographical characteristics of Greece and of the
National Health System, one more aim was to propose policies that intend to improve
the quality of provided services.
Subjects and methods
In order to establish the knowledge level of physicians about COPD and the effect, in
this, of an intensive training program, a training weekend was organized and nine GPs
were involved. 8 of them came from Health Centres (HC) from rural and remote areas
of Crete and one of them from an urban HC of Athens. Before and after the start of training, a questionnaire was administered to participants to ascertain their level of
knowledge relatively to COPD. With another questionnaire they were asked to record
their opinions relatively to the usefulness and relevance of the program. Then, for the
purpose of determining the implications of such an educational initiative on the
quality of life of patients with COPD, two groups of patients were created. One group
was monitored by physicians who participated in the training weekend and the other
by a physician who was not involved in it. By using quality's of life questionnaires
(CRQ-SAS and QOL-RIG), in the beginning and six months later, were recorded the
differences between them. In addition, 121 smokers in Alonakia area in Northern
Greece who visited the HC for whatever reason, were invited to participate in a
survey concerning their smoking habits. A questionnaire was used, designed to
include topics related to their attitudes and concerns as regards to smoking habit.
Results
In the results that were related to the training weekend was recorded statistically
significant difference in median values before and after training, as an indication of
direct positive impact on the level of knowledge and management of COPD from the
participants. The largest differences occurred in topics related to management of
smoking cessation [from 3 to 6 (p = 0.011)] and to the ability to perform spirometry
[from 2 to 5 (p = 0.010)]. However, this change wasn’t translated by an improved of
quality of life and lung's function (controlled by FEV1) of patients enrolled in this
study. Regarding smoker patients and their smoking habits, it was found that the
average daily consumption of cigarettes was 20.2 +/- 12.4 (range 2-60) and the
average pack- years consumption was 31.8 +/- 30. 4 (range: 1-150 pacκ- years).
Moreover, 61.2% declared his intention to quit smoking during the next 12 months.
The most smokers (87, 71.9%) had made one or more quit attempts in the past, but
only 8 (6.6%) of them called personalized medicine help in their effort. Among the
participants, the most important reason of their intention of quitting was the fear of a
possible disease associated for with smoking [60/74 (81.1%)], while the cost of
smoking was reported as the cause of quitting in 7 out of 74 (9.5%) smokers who
were intending to quit smoking in the next year. Despite the fact that 63 (52.1%) of
smokers declared that the cost of tobacco affects their daily cigarette consumption,
63.6% of respondents referred that they had no intention to quit even if the cost was
going to be doubled. Conclusions
These results clearly illustrate that a fast and intensive program aiming to primary
care doctors can provide benefits in terms of raising the level of their knowledge
about COPD. However, such a process in itself does not guarantee the translation of
positive results in improving the quality of life of patients with COPD. Regarding the
smoking habit of smokers in rural areas, it seems that the main motivation for the
smoking cessation is the fear of a disease associated with this habit, but nevertheless
their intention to quit was very small even if the cost of tobacco was going to be
doubled. Finally, taking into account the personal experience and literature review are
proposed health policies so as to improve the quality of provided health services
which will be based on incentives for research, on changes of structure function of
primary care settings and on evaluation processes of the expected results
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Διαχείριση της χρόνιας αποφρακτικής πνευμονοπάθειας στην πρωτοβάθμια φροντίδα υγείας και στη γενική ιατρική
