居家气喘治疗改善成年患者的控制


  【24drs.com】根据在线发表于11月24日美国医学会内科医学期刊(JAMA Internal Medicine)的一篇研究结果,患有气喘且控制不佳的低收入成年人,如果接受社区健康工作者一年5次的居家访视,可以改善控制与生活质量。
  
  华盛顿西雅图金郡公卫部门James Kriege医师等人,研究了金郡366名气喘控制不佳的研究对象:177人有接受教育、服务以及社区健康工作者的协同照护之介入,189人接受的是一般照护。
  
  介入组在无症状天数(每2周无症状天数2.02天[95%信心区间0.94 - 3.09天;P < .001]以上)与生活质量都显著改善,生活质量之测量是依据迷你版气喘生活质量问卷,平均增加0.50分(95%信心区间0.28 - 0.71分;P < .001)。
  
  不过,介入并未使紧急照护之使用变更少。研究者指出,两组在最近12个月的紧急照护减少程度相似,介入组平均从3.46减少到1.99次,控制组从3.30减少到1.96次。每位患者的介入费用约为1300美元(以2013年的美金币值计算),远低于一年份的吸入型皮质类固醇费用。
  
  Alameda健康体系的Harrison J. Alter医师在受邀评论时写道,他对研究结果印象深刻,特别是顾虑到有中度到严重气喘、较难寻求帮助达到控制的劳工弱势阶层。
  
  他写道,未能减少紧急医疗照护虽仍需要相关的成本、可能抵销节省的费用,但是整体的助益仍大,该是调整对于此严格定义之成功看法的时候了。
  
  Alter医师结论表示,我们提供照护的主要目的不应只是减少使用医疗照护,有时候,在日常实务上,医疗体系中的某些成员或许确实希望如此,身为医师、研究者、师者、治疗者的我们不能忽略目标的实际重要性。但是,如果每个医疗策略都要检视它在体系中的效果,我们会发现反而会阻碍病患就诊。
  
  社区健康工作者在访视时提供教育、支持以及协同服务,他们是区域招募的全职员工且教育程度为高中以上(一般教育发展)。他们母语都是西班牙文且自己有气喘经验,接受80小时的课程训练以及2周实习。
  
  除了促进照护与追踪沟通,介入的照护对象还会收到过敏原无法穿透之床窗扉以及低排放的真空吸尘器等工具。豢养有毛/羽毛的宠物者、曝露于二手菸的非抽菸者,则是收到高效能微粒空气过滤器。
  
  研究作者结论指出,我们预期,这种介入方式可以由健康组织服务多元化、低收入对象而迅速复制,可以减少气喘相关的健康资源不对等问题。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_idno=7139&x_classno=0&x_chkdelpoint=Y
  

In-Home Asthma Treatment Improves Adults' Control

By Marcia Frellick
Medscape Medical News

Low-income adults with uncontrolled asthma had improved control and quality of life when they received five home visits per year by community health workers, according to study results published online November 24 in JAMA Internal Medicine.

James Krieger, MD, MPH, from Public Health–Seattle and King County in Washington, and colleagues studied 366 participants from King County with uncontrolled asthma: 177 who received the intervention, which included education, service, and care coordination by community health workers, and 189 who received usual care.

The intervention group had significantly greater increases in symptom-free days (2.02 days [95% confidence interval, 0.94 - 3.09 days; P < .001] more for every 2 weeks) and quality of life, as measured by the Mini Asthma Quality of Life Questionnaire, which increased an average of 0.50 points (95% confidence interval, 0.28 - 0.71 points; P < .001).

However, the intervention did not result in a significant decrease in use of urgent care. Urgent care episodes during the last 12 months decreased similarly in both groups from 3.46 to 1.99 episodes, on average, in the intervention group and from 3.30 to 1.96 episodes in the control group. The intervention cost about $1300 (in 2013 US dollars) per participant, which is substantially less than a 1-year supply of an inhaled corticosteroid, the researchers note.

In an invited commentary, Harrison J. Alter, MD, from the Alameda Health System in Oakland, California, writes that he was impressed with the results, especially considering that the target population of working-poor patients who have moderate to severe asthma is typically hard to help achieve control.

He writes that the lack of a reduction in urgent medical care to offset the intervention cost should not overshadow the benefits.

"[I]t may be time to pry ourselves loose from such a strict definition of success," he writes.

"The main purpose of our care should not be to reduce medical care use. Sometimes, in daily practice, it can feel as though certain actors in our system wish it were so. We cannot, as clinicians, investigators, teachers, healers, ignore the reality of the importance of this goal. But if in every medical effort we turn to check its effect on the system, we may find ourselves turning away from the patient," Dr Alter concludes.

The community health workers provided education and support and coordinated services during their visits. They were full-time employees recruited from the area served and had high school or equivalent (general education development) degrees. They were native Spanish-speakers and had personal experience with asthma. They received 80 hours of classroom training, followed by biweekly training.

In addition to their enhanced care and follow-up communications, intervention participants received tools such as allergen-impermeable bed casements and a low-emission vacuum cleaner. Those with furry and/or feathered pets and nonsmokers who were exposed to second-hand smoke received high-efficiency particulate air filters.

"We anticipate that this intervention could be readily replicated by health organizations serving diverse, low-income clients, suggesting that it could reduce asthma-related health inequities," study authors conclude.

This study was supported by the National Institutes of Health/National Institute of Environmental Health Sciences and the National Center for Advancing Translational Sciences. The authors have disclosed no relevant financial relationships. Dr Alter owns less than $50,000 stock in Gilead Sciences.

JAMA Intern Med. Published online November 24, 2014.

    
相关报导
运动程度高与女性的气喘控制不佳有关
2015/12/2 下午 02:04:43
研究认为运动可改善气喘控制
2015/11/18 上午 09:42:28
鸡蛋过敏最可能被克服
2012/11/14 下午 04:05:00

上一页
   1   2   3   4   5   6   7   8  




回上一页