Summary
With the help of the most prominent Chinese social medium Wechat, which made a terrific contribution to the response rate of the survey, this survey allowed more insight into primary care physicians’ knowledge on COPD, asthma, CAP and influenza. However, from the results we can see that primary care physicians’ knowledge on these four common respiratory diseases was significantly poor. On the whole, either the average score of the questionnaire or the average score of each disease was less than 60% of the corresponding part. Foremost, physicians can’t correctly identify the clinical features of each disease. Only 61.4% of physicians were aware of the clinical features of COPD, less than half of them knew clinical characteristics of asthma and influenza (48.7% and 42.5%, respectively). What’s worse, they knew less about the diagnosis criteria of asthma, CAP and influenza. Only 8.1%, 16.1% and 1.0% of them can make right diagnosis of asthma, CAP and influenza, respectively. Although, it was gratified to see that more than 85% of the primary care physicians knew how to diagnose COPD, almost half (45.3%) of respondents didn’t know the criteria for GOLD II COPD. This was related to a series of policies[17-19] on COPD management which have increased and strengthened the relative training on COPD.
Even though physicians in township hospitals had a better knowledge of these diseases, the knowledge level of influenza between them was similar, which may be due to the incidence of influenza has increased yearly in China so that the government has attached great importance to influenza training. The knowledge of treatment was even worse. Compared with the high correct rate of COPD diagnosis, a very small proportion of physicians were aware of bronchodilators for COPD. As the most two common chronic non-communicable respiratory diseases, only 8% and 3% were aware of the management of stable COPD and asthma, respectively.
Above all, physicians at township hospitals had a better knowledge level than community hospital physicians, which provided a possibility for referrals between township hospitals and community hospitals for common respiratory diseases, but a sound knowledge reserve is a prerequisite. From the above, we can see that primary care physicians’ knowledge on these common respiratory diseases needs to be greatly improved. However, in view of the outstanding performance of primary care in combating COVID-19 pandemic, we also believe that with high-quality training primary care physicians will manage these diseases very well.
Strengths and limitations
This is the first and largest study to assess primary care physicians’ knowledge on CAP, asthma, influenza, and COPD simultaneously, with such a huge sample, high response rate and broad geographical areas in China. Although only 65.1% of the questionnaires were analyzed finally, the sample size of the study was still the largest of its kind. Though the sample population was unevenly distributed, it was sufficient to get an overview of the current knowledge level of primary care physicians about these four common respiratory diseases.
However, due to the survey was conducted on conferences, the number of attendees from each area were related to the places of the conferences, which resulted in some areas were overrepresented while some were underrepresented. Thereby the generalizability of the findings for some provinces or cities was limited. For more comprehensive view to present a thorough picture of knowledge level of primary care physicians in specific areas, surveys like this but with more physicians to take part in are needed so as to provide more individualized and targeted training for certain regions.
Comparison with existing literature
There were studies to investigate primary care physicians’ knowledge of COPD and asthma[20-25] around the world, and the conclusions were nearly the same, that is, primary care physicians’ knowledge of COPD and asthma were insufficient. Similar studies have also been carried out in China, but in relatively smaller sample size and were only regionally based[26, 27]. Nevertheless, seldom studies focused on knowledge assessment of influenza either in the world or in China. There was one study assessed the knowledge of CAP, but just in one city[28].
Implications for Research and/or practice
Respiratory diseases account for significant health service and societal costs in China, but the knowledge of common respiratory diseases among primary care physicians is not optimistic. Up to 2017, there were less than 8000 respiratory physicians registered in China[1]. However, it’s far from enough for these respiratory physicians to manage more than 140 million people with respiratory diseases. It is a crisis time for respiratory diseases management in China and primary care must take action now. Although the current knowledge level of primary care physicians were unsatisfactory, the training programs initiated by CARDPC across the country is going on. Action Now study laid the foundation for the follow-up training programs and future quality improvement work. An updated education program would be designed based on these findings, then a set of courses that are more targeted, practical and more in line with primary care physicians' needs will be launched. Furthermore, under the furtherance of CARDPC, the first guideline of COPD, asthma and CAP management in primary care have been released, and medications for these common respiratory diseases have been introduced to primary care institutions in some areas with the help of CARDPC. Up to the end of 2018, there were 29 branches of CARDPC spread in 29 provinces or municipalities[29]( Supplementary figure 2).
As a member of the International Primary Care Respiratory Group (IPCRG), CARDPC actively participates in primary care research work and international collaborations on respiratory diseases, and strives to build a comprehensive respiratory diseases management system in primary care settings in China. In the COVID-19 pandemic, CARDPC also played a leading role in the prevention and control in primary care in China. We believe that with the attempts and facilitation of CARDPC, management of respiratory diseases in primary care in China will make great progress in the near future.