Epidemiological characteristics and effectiveness of Chronic obstructive pulmonary disease intervention in the two districts of Bac Ninh province

patient; The degree of airway obstruction of a patient with COPD according to GOLD; The proportion of patients with co-morbidities; Number of acute COPD cases in the year. * Group of indicators on related factors: Personal factors such as age, gender, medical history; Behavioral factors such as tobacco addiction, waterpipe tobacco; Boil wood, straw, honeycomb charcoal, sedentary; Exercise; Environmental factors: Living in places with air pollution; Working in hazardous environment, air pollution; Health care elements; Communication elements; Examination and preventive counseling for COPD. * Group of KAP indicators to prevent COPD. * Group of performance indicators for COPD preventive measures: - Building solutions: Solutions 1, 2, 3 and 4 at Que Vo General Hospital -The involvement of health workers managing COPD patients at district hospitals, hospital management, local authorities, departments, the general public and health care. - Participation of the sick people COOPD. - Acceptance of the model by the Que Vo DK hospital hospital leadership and staff. * Group of indicators to evaluate intervention effectiveness - Change the patient's KAP to prevent COPD; The index group assesses the effectiveness of improving the health of people with COPD as the manifestations of COPD; -Group of qualitative indicators on patient health, economic and social efficiency. * Classification of COPD stage according to GOLD 2011. * Assessing the degree of dyspnea: Based on the MRC questionnaire (British Medical Research Council) 2.2.4.4. Assessing the Knowledge, attitudes and practices (KAP) of COPD patients. Divide into 3 levels based on results: Score over 70%: Ranked fairly good, good; Score from 50% - 70%: Ranked average; Score <50%: Ranked Weak. 2.2.4. Research data collection techniques and tools -Directly interviewing the risk subjects in the community with COPD questionnaire in the community, combined with clinical examination and respiratory function measurement. - Directly investigating the patients who are treated and treated with COPD according to the COPD case record, combined with clinical examination and respiratory function measurement. * Interview techniques: Directly interview the research subjects. The survey staff was trained on interviewing techniques and filling out forms. Investigators are also allowed to practice and assess the completeness, objectivity and interview skills. The questionnaire was developed by public health experts in collaboration with COPD experts. Cards are built according to the process. * Clinical examination: Cases with respiratory function measurements that meet the criteria identified as having obstructive hyperventilation (FEV1/FVC <70%) will be clinically examined and in-depth interviewed for pathological status. After each examination day, the interviewer must verify the completeness and accuracy of the information and sum up the data according to the form. This work is done by specialized doctors in COPD. 2.3. Developing the intervention models 2.3.1 Objectives of the intervention: Manage and treat COPD patients in Que Vo General Hospital in the best way. 2.3.2 Intervention solutions - Building a COPD disease management unit at Que Vo general hospital - Establishment of COPD club - Respiratory rehabilitation program - COPD outpatient management 2.3.3. How to proceed - Training of staff involved in interventions: grassroots health workers, community leaders, hospital officials. - Conducting the health education communication for COPD patients: - For the community and the people: Mainly communication and communication against COPD in the community by integrating with other activities of the commune to communicate with the people.. 2.3.3.4. Contents of evaluation: - Comparing the changes of knowledge, attitudes and practices of COPD prevention of patients after the intervention. - Comparing the changes in health status of patients before intervention - Evaluating the intervention results based on effectiveness index and intervention effectiveness: + Efficiency index % = In which: p1 is the pre-intervention rate and p2 is the post-intervention ratio. + Intervention effectiveness = intervention effectiveness index - control effect index 2.5. Data processing methods: Data were entered and analyzed in SPSS version 13.0 program. 2.6. Ethical issues in research: The research proposal was approved by the scientific council of Thai Nguyen University of Medicine and Pharmacy. Chapter 3. RESEARCH RESULTS 3.1. Epidemiological characteristics of COPD 3.1.1. General information about the studied subjects 3.1.2. Epidemiological characteristics of COPD Chart 3.2 shows the prevalence: Among 2221 surveyed people, 79 people were found with COPD, accounting for 3.6%. Chart 3.3 shows the distribution of COPD by age, gender and occupation: The proportion of people aged ≥60 years with COPD is higher than people <60 years old (6.1% and 0.9%). The proportion of men with COPD is higher than that of women (5.7% and 2.1%); Farmers have a higher incidence of COPD than other people with other occupations (3.6% and 2.9%). Chart 3.4 shows the prevalence of COPD in Que Vo district is 3.9%, Thuan Thanh is 3.2%, but the difference is not statistically significant (p> 0.05). Chart 3.5 shows that COPD rate by airway obstruction level mainly in stage GOLD 2 accounted for 49.4%; followed by GOLD 3 accounted for 35.4% and the lowest in GOLD 1 accounted for 10.1%. Box 3.1. Current situation of COPD in communes of two surveyed districts Opinions of some community leaders: - In the past, there was little talk about chronic obstructive pulmonary disease but now it is more talkative and increasing number of patients. - Most people with the disease are aged 40 years or older. -The majority of infected people are men. Opinions of commune health officials: - Patients visiting and managing chronic obstructive pulmonary disease in the hospital are increasing month by month. - About age shows that the majority of people infected are aged over 40 years old. - About gender, the majority of patients are men. 3.2. Several factors related to COPD 3.2.1. Several factors related to COPD through community surveys Table 3.7. shows the relationship between factors such as age, gender of the subjects with COPD (p <0.05). Table 3.8. shows the relationship between the history of bronchial asthma, tuberculosis of subjects with COPD (p <0.05). Table 3.9. shows a link between some living habits of subjects such as tobacco, pipe tobacco addiction; boil firewood and straw; lives in air pollution and is sedentary with COPD (p <0.05). Table 3.10. Shows the relationship between some exercise habits of subjects with COPD such as sport and other physical activities (p <0.05). Table 3.11. shows that the only correlation between communication is the role of health workers and COPD (p <0.05). Table 3.12. shows a correlation between medical examination and counseling for prevention of COPD and COPD (p <0.05). The results of logistic regression analysis show that the rate of men with COPD is 2.9 times higher than that of women, people from 60 years and older have 5.94 times higher incidence of COPD than those with people under 60 years of age; smokers and pipe tobacco users have the rate of 11.16 times higher than those who do not smoke, pipe tobacco; Those who have direct contact with kitchen smoke have a 6.17 times higher incidence of COPD than those who do not have direct contact with kitchen smoke. 3.2.2. Several factors related to COPD through hospital investigations Researching 260 patients who are managed the treatment at the Que Vo and Thuan Thanh Hospitals, we have obtained some results as follows: * Knowledge, attitude and practice of preventing COPD: The results in Table 3.14 show that the rate of patients who know about dyspnea accounts for the highest proportion (71.9%), the lowest is the rate of knowing about fatigue (36.4%). In the two district hospitals, there was no significant difference in the proportion of patients who knew about the symptoms (p> 0.05). The results in Table 3.16. show that the attitude about COPD, the proportion of patients who believe that COPD is preventable and believe that COPD exacerbations can be treated in Que Vo and Thuan Thanh districts are similar; The proportion of people who believe that COPD is a dangerous disease and do not smoke, scientific activities is the best preventive measure in Thuan Thanh district is higher than Que Vo district, but it is not statistically significant (p> 0). , 05). The results in Chart 3.9. show that 91.5% of the patients have not practiced the correct treatment of acute COPD, of which Que Vo district has only 6.8% lower treatment rate than the district. Thuan Thanh (10.2%); However, it is not statistically significant (p> 0.05). The results in Table 3.19. show that 84.6% of patients do not practice proper exercise and respiratory rehabilitation in COPD prevention. There is no difference between the two districts (p> 0.05). * The basic signs of disease Table 3.20. shows the degree of dyspnea of 260 patients. The proportion of patients with signs of dyspnea is quite high (70.0%); The level of difficulty breathing is highest in Grade 2 (34.1%), followed by Grade 3 (33.5%), Grade 4 is 26.9% and the lowest is Grade 1 accounting for 2.2%. There was no difference in the rates of dyspnea and the levels of dyspnea in the two districts. Table 3.22. Distribution of the degree of airflow obstruction according to GOLD Stages according to GOLD Que Vo Thuan Thanh General Quantity % Quantity % Quantity % p Stage 1 11 8,3 19 15, 30 11,5 >0,05 Stage 2 36 27,1 40 31,5 76 29,2 >0,05 Stage 3 45 33,8 34 26,8 79 30,4 >0,05 Stage 4 41 30,8 34 26,8 75 28,8 >0,05 Patients mainly in GOLD stages 2,3,4 (29,2%; 30,4%, 28,8%), the rate of GOLD 1 is the lowest (11.5%). There is no difference in the proportion of COPD stages according to GOLD between the two districts (p> 0.05). Figure 3.10 shows that the proportion of patients with comorbidities accounts for 12.3%. There is no difference in the incidence of co-morbidity between the two districts (p> 0.05). Table 3.23. Number of exacerbations in the year (n = 260) District Average p Que Vo 1.79±0.817 >0.05 Thuan Thanh 1.84±0.877 General 1.82±0.845 In the last 01 year, the average number of hospitalizations of patients with COPD is 1.82 times. There is no difference in the average number of hospitalizations between the two districts (p> 0.05). Place of detecting COPD: All patients with COPD were found to be hospitalized (100%). Table 3.24. shows that the proportion of patients hospitalized 2 or more times for COPD exacerbations during the year in the age group 60 years and older and in men is higher than the age group under 60 years and women; however the difference is not clear (p> 0.05). Table 3.25. Relationship between smoking history and direct exposure to kitchen smoke and number of exacerbations during the year Number of exacerbations History ≤ 1 time/year ≥ 2 times/year p Quantity Rate (%) Quantity Rate (%) Smoking Yes 59 33.3 118 66.7 <0.05 No 50 60.2 33 39.8 Kitchen smoke Yes 54 37.2 91 62.8 >0.05 No 55 47.8 60 52.2 The rate of hospitalization with 2 times or more of COPD exacerbations during the year in the group with a history of smoking was 66.7% higher than the group without smoking history and the difference was statistically significant (p 0 , 05). Table 3.26. shows that there is no relationship between co-morbidity and the number of exacerbations in the year: The rate of hospitalization of 2 or more episodes for COPD exacerbations in the group with Comorbidity is 62.5% higher than No co-morbidity group (57.5%), however the difference is not clear (p> 0.05). Qualitative research results: Box 3.3. Several factors are involved in COPD Comments from some community leaders: - Those who are addicted to tobacco and pipe tobacco are susceptible to COPD. - Smoke caused by burning honeycomb charcoal in families makes COPD increase. - Currently, environmental pollution, especially the smoke in polluted air, makes COPD of people increasing - The disease is related to gender, the more men suffer than the woman, the older one gets. - COPD is common in people who have had some illnesses such as asthma, chronic bronchitis or tuberculosis ... - The disease often occurs in people who are sedentary. Comments from grassroots health officials: - Those who smoke, pipe tobacco are at high risk of developing COPD. - The smog factor in families caused by boiling straw, the honeycomb charcoal in families, causes COPD to increase. - Currently, due to the increasing environment of dust and smoke, air pollution contributes to the increase of COPD in the community. - Gender factors are related to the disease, the more men get infected, the older the disease is. - People with a history of a number of diseases such as asthma, chronic bronchitis or tuberculosis ... or COPD. - People who are sedentary often get sick - If there is less chance of being examined and consulted by health staff. 3.3. Results of community intervention activities 3.3.1. The basis for developing intervention solutions Due to limited resources, we focused on hospital interventions. After discussing with hospital managers and health workers to directly examine and treat patients with COPD, we selected 04 main solutions: 1) Building a COPD disease management unit at Da Nang Hospital. Faculty of Que Vo. 2) Building COPD Club. 3) Develop a respiratory rehabilitation program. 4) Managing COPD outpatient treatment. 3.3.2. Effectiveness of intervention models Table 3.34. shows the effectiveness of improving general knowledge about COPD prevention is very high up to 630.0%. In particular, in the intervention group this rate increased from 9.3% to 69.8%. In the control group 13.9% up to 16.7%. Table 3.35. shows the effectiveness of improving the overall attitude on COPD prevention After the intervention, the percentage of patients in the intervention group with the rate of good attitude in COPD prevention increased from 60.5 to 100.0%; In the control group increased from 63.9% to 66.7%. Effectiveness of intervention is 61.0%. Table 3.36. The effectiveness of interventions to improve the proportion of patients who implement COPD prevention measures Time Subject Before intervention After intervention Efficiency index (%) Quantity % Quantity % Que Vo (n = 43) 3 7.0 25 58.1 733.3 Thuan Thanh (n = 36) 2 5.6 4 11.1 100.0 Effectiveness of intervention (%) 633.3 The effectiveness of practice improvement on implementation of COPD preventive measures is very high, up to 633.3%. In which, in the intervention group, the rate increased from 7.0% to 58.1%. In the control group 5.6% up to 11.1%. Table 3.37. Effectiveness of intervention the general practice rate of the studied subjects Time Subject Before intervention After intervention Efficiency index (%) Quantity % Quantity % Que Vo (n = 43) 1 2.3 18 41.9 1700.0 Thuan Thanh (n = 36) 3 8.3 4 11.1 33.3 Effectiveness of intervention (%) 1666.7 After the intervention, the proportion of patients in the intervention group who have good general practice in COPD prevention and control increased from 2.3 to 41.9%; In the control group, it increased from 8.3% to 11.1%. Effectiveness of intervention is 1666.7%. Table 3.38. Effectiveness of COPD manifestations Time manifestations Before intervention After intervention Efficiency index (%) Quantity % Quantity % Dyspnea Que Vo (n = 43) 27 62.8 10 23.3 63.0 Thuan Thanh (n = 36) 26 72.2 25 69.4 3.8 Effectiveness of intervention (%) 59.1 The effectiveness of intervention to improve the health of patients is quite high in the intervention group showing difficulty in breathing reduced from 62.8% to 23.3%. Table 3.40. Number of exacerbations in the year Place Time Districts p Que Vo Thuan Thanh Before intervention 1.26 ± 0.82 1.41 ± 0.84 > 0.05 After intervention 0.56 ± 0.55 1.36 ± 0.64 <0.05 p <0.05 > 0.05 The average number of exacerbations after intervention in the intervention group changed clearly from 1.26 exacerbations/year to 0.56 exacerbations/year, with p 0.05. Qualitative research results: Box 3.6. The effectiveness of COPD management and treatment solutions Opinion of COPD management and treatment staff about the outcome of the intervention: - Knowledge of behavioral attitudes about management and treatment of patients with COPD is much better, the number of weaknesses is reduced. - The main symptoms of the patient such as shortness of breath, cough, sputum ... are reduced. - The number of exacerbations of COPD patients is also greatly reduced. - The research intervention measures are easy to implement, high economic efficiency and easy to maintain. Opinions of patients who are under management and treatment of COPD: - After a period of management and treatment of patients with COPD, the main symptoms such as difficulty breathing, cough, sputum ... are reduced. - The number of exacerbations of COPD is also greatly reduced. Chapter 4. DISCUSSION 4.1. Epidemiological characteristics of Chronic obstructive pulmonary disease in Que Vo and Thuan Thanh districts of Bac Ninh province in 2015 * Incidence of Chronic obstructive pulmonary disease: Our research results show that the prevalence of COPD is 3.6%. Our research results are in accordance with the research results in Vietnam which range from 2.0 to 7.0%. According to a study by Ngo Quy Chau in Hai Phong in 2005, the prevalence of COPD was 4.7% and 6.89%, respectively, in people over 40 years old. Compared with research results in the world, according to the 2011 CDC study at ILLINOIS, the prevalence of COPD in adults is about 6.1%. Recent studies on COPD in Asia-Pacific show that the overall COPD rate is about 6.2%; ranging from 4.5% in Indonesia to 9.5% in Taiwan in 2012. Our research results show that the prevalence of COPD mainly in the GOLD 2 period accounted for 49.4%; followed by GOLD 3 accounted for 35.4% and the lowest in GOLD 4 accounted for 5.1%. * Incidence of COPD and a number of related factors: About gender, research results show that among COPD patients, men account for a high proportion (64.6%); The percentage of women is 35.4%. The study of Nguyen Mai Huong among 100 patients also showed that 89.0% were male and 11.0% were female. In the study of Phan Thu Phuong et al, the overall prevalence of COPD for both sexes was 2.3 % (the prevalence in men is 3% and in women is 1.7%. About the age of people with COPD in the study, the average age is 60.8 years old. In the study of Ngo Quy Chau in 2011 , the average age is 68.1, of Phan Thu Phương in 2013 was 69.25 ± 10.08. Our research results show that people with some of the leading behaviors of COPD are working in hazardous environment, polluted air (85.6%), living in air pollution. (78.6%), burning wood, straw, honeycomb ... accounts for 31.7%, at least sedentary (1.5%). The percentage of people who are addicted to tobacco and pipe tobacco is high (13, 5%) ... Smoking is the most important cause of COPD, according to WHO statistics, about 80-90% of patients with COPD are smoking. On the other hand, regular exposure to kitchen smoke can Due to economic conditions and the habit of using charcoal, firewood or honeycomb for cooking, changing their bad habits requires a process. However, today this habit has been replaced by another habit of cooking a gas stove which is much less toxic. On the other hand, there are no specific health education programs to guide patients to practice self-rehabilitation and proper exercise. The practice of leading research subjects is another activity. (in fact, manufacturing workers) account for the highest proportion (39.4%), while physical training is the first to walk (20.4%), or to nourish (10.5%). A number of recent studies have shown that in people with COPD who have appropriate exercise and rehabilitation programs, they can reduce up to 50% of patients' hospitalization rates due to exacerbations. Physical exercise is the most important factor in the rehabilitation process in people with COPD. The history of chronic illnesses of the study subjects is also quite high, including some high-risk diseases with COPD, it was bronchitis (55.6%), low as tuberculosis (2%) or bronchial asthma (1.4%). Regarding the consultation consultations for COPD prevention of research subjects, the results showed that The percentage of people consulted for COPD prophylaxis is very low (14.0%), the majority is not. This shows that the provision of health services for patients is not well implemented. However, our research results are higher than the results of COPD prevention project in 2011 when only 5% of patients were regularly examined. Therefore, improving the knowledge and attitudes of patients has a great influence on this process. Research results at the hospital show that exacerbation of COPD is a worsening of the previous stable COPD stage that needs to change in daily treatment. The results also showed that the average number of hospital admissions in the past year was 1.82, lower than that of Khổng Thục Chinh with the average number of exacerbations per year of 139 COPD patients being 3.47±1.27 exemptions/year. Our research results are similar to those of Chu Thi Hanh in 2013 conducted on patients with stable stage COPD, which was monitored at COPD management room - Bach Mai Hospital from January 1, 2013 to September 30, 2013 showed the average number of exacerbations/year to be 1.9. Exacerbation of COPD quickly reduces the respiratory function of the patient.After each exacerbation, the airway of the patient will become more inflamed, the lung function will be seriously damaged, many patients can not even recover. The lung function is the same as before the exacerbation. More dangerous, the patient is at high risk of death if not treated promptly. Therefore, the detection and recognition of signs of exacerbation are extremely important. At the same time, prevention and treatment are of utmost importance to reduce the occurrence of exacerbations. In our study, 100% of patients were diagnosed with COPD in hospitals. even at district, provincial and other hospitals. This shows that only when the symptoms of a very serious or even very ill patient are admitted to the hospital for a diagnosis and detection of COPD; or maybe the patient came for another illness and found out that he had COPD; Thus, it can be seen that COPD has not really been concerned by people and communities, necessary to improve people's knowledge, attitudes and practices about COPD. 4.2. Several factors related to Chronic obstructive pulmonary disease in studied area 4.2.1. Survey results in the community: Our research results show a correlation between factors such as age, gender of subjects and COPD. With p <0.05, it is shown that the elderly and men tend to have higher disease than the young and the women. 4.2.2. Research results at the hospital: Research results on 260 patients with COPD inpatient treatment at 02 general hospitals of Que Vo district and general hospitals of Thuan Thanh district, Bac Ninh province with the design of cross-sectional descriptive research have shown the results: About the patients' knowledge about COPD: The research results show that the patients with good general knowledge about COPD are only 46.9%, of which Que Vo district is 52.6% higher than in Thuan Thanh district. However, this difference is not statistically significant (p> 0.05). The proportion of patients with good knowledge is not high, which shows that it is necessary to strengthen health education for patients about COPD, thereby helping patients gain knowledge for self-prevention and care. and protect your health; avoid dangerous complications of the disease, and slow down the progression of the disease. Attitudes of COPD patients: Our research results show that the proportion of patients who believe that COPD is preventable and believe that COPD exacerbations can be treated in Que Vo and Thuan Thanh districts is similar. same. Regarding COPD prevention practice of research subjects: it showed that only 15.4% of patients had proper practice on physical exercise and respiratory rehabilitation in COPD prevention, the remaining 84.6% disease is not good; Specifically, the rate of good practice of patients in Que Vo hospital was 17.3% and Thuan Thanh district was 13.4% but the difference was not statistically significant between the two districts. About the manifestations and related factors: among the symptoms, shortness of breath is the