摘要
目的从卫生经济学角度探索基于家庭医生签约服务的慢性阻塞性肺疾病(简称慢阻肺)筛查的成本效果和成本效益。方法2023年1—10月,采用立意抽样、横断面调查的方法选取1040例在上海市闵行区华漕、古美社区卫生服务中心体检的、年龄60~75岁的老年人为研究对象。研究对象分为对照组与观察组,对照组532名,采用常规社区宣教、体检中心为主导的方式开展慢阻肺筛查;观察组508名,采用紧密医联体支持下的家庭医生为主导的服务方式开展筛查,两组筛查内容均包括评估问卷初筛、复筛、肺功能检查、支气管舒张试验、CT检查等;比较两组的筛查依从率、阳性率及成本效果、成本效益,评价筛查成效。结果通过初筛及复筛,查见两组对象慢阻肺高危人群及患者合计251例,占24.13%,其中高危人群222例,占比21.35%,确诊患者29例,占比2.79%。观察组问卷初筛、复筛、肺功能检查、支气管舒张试验、确诊及后续CT检查的依从率均明显优于对照组(χ^(2)=33.563、41.425、24.842、17.363,均P<0.05)。两组对象筛查发现的高危人群及患者占比有明显差异,观察组高危人群及患者占比较高(χ^(2)=44.880,均P<0.05)。观察组问卷初筛、肺功能检查、支气管舒张试验、CT检查的阳性率均明显高于对照组(χ^(2)=29.191、11.313、12.370、4.429,均P<0.05)。对照组、观察组筛查的成本分别为3.61万元、5.39万元,两组总计9.00万元。对照组、观察组复筛项目中的肺功能检查费的成本分别为1.44万元、2.45万元,合计3.89万元,占比43.19%,在各项成本中占比最高。对照组、观察组及全体对象每发现并筛出1例慢阻肺高危人群及患者的人均成本分别为429.45元、322.75元、358.46元;两组初筛、复筛人均成本的比较显示,观察组人均成本明显低于对照组(χ^(2)=20.396,P<0.05)。两组对象合计的人均净效益为0.37万元,效益成本比为43.50。观察�
Objective To explore the cost-effectiveness and cost-benefit of chronic obstructive pulmonary disease(COPD)screening and intervention based on family doctor contract services.Methods From January 2023 to October 2023,using purposive sampling and a cross-sectional survey method,1040 individuals aged 60 to 75 years who underwent physical examinations at community health service centers in Shanghai Minhang district were selected as research subjects.The subjects were divided into a control group(n=532)and a study group(n=508).The control group received conventional community health education and participated in a COPD screening and intervention program provided by the examination center.The study group received COPD screening and intervention provided by contracted family doctors under a tightly integrated medical consortium.The screening content for both groups included initial and follow-up risk assessment questionnaires,pulmonary function tests,bronchodilator tests,and CT scans.A comparative analysis was conducted on the screening compliance rate,positive rate,and cost-effectiveness and cost-benefit between the two groups.Results A total of 251 individuals at high risk for COPD and confirmed COPD patients were identified through initial and re-screening in both groups,accounting for 24.13%of the subjects,including 222 individuals at high risk(21.35%)and 29 confirmed patients(2.79%).The study group had significantly higher compliance rates in questionnaire-based initial screening,questionnaire-based re-screening+pulmonary function tests,bronchodilator experiments,diagnosis,and subsequent CT scans than the control group(χ^(2)=33.563,41.425,24.842,17.363,all P<0.05).There were significant higher proportions of high-risk individuals and patients identified through screening in the study group than those in the control group(χ^(2)=44.880,all P<0.05).The study group had significantly higher positive rates of questionnaire-based initial screening,pulmonary function tests,bronchodilator experiments,and CT scans than th
作者
宦红梅
刘帅
张驰
慕永红
曹维金
揭志军
金鸣
Huan Hongmei;Liu Shuai;Zhang Chi;Mu Yonghong;Cao Weijin;Jie Zhijun;Jin Ming(Gumei Community Health Service Center of Minhang District,Shanghai 201100,China;Huacao Community Health Service Center of Minhang District,Shanghai 201107,China;The Sino-British College,University of Shanghai for Science and Technology,Shanghai 200031,China;Department of Respiratory and Critical Care Medicine,Shanghai Fifth People′s Hospital affiliated to Fudan University,Shanghai 200240,China)
出处
《中华全科医师杂志》
2024年第9期935-943,共9页
Chinese Journal of General Practitioners
基金
上海市闵行区自然科学研究课题(2022MHZ065)
复旦-闵行健康联合体合作项目(2021FM23)。
关键词
肺疾病
慢性阻塞性
成本及成本分析
多相筛查
医师
家庭
Pulmonary disease,chronic obstructive
Costs and cost analysis
Multiphasic screening
General practitioners
