A virtual asthma clinic for children: fewer routine outpatient visits, same asthma control
A virtual asthma clinic for children: fewer routine outpatient visits, same asthma control
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儿童哮喘虚拟诊所：减少常规门诊，相同的哮喘控制
DOI：
10.1183/13993003.00471-2017
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发表时间：
2017-10-01
影响因子：
24.3
通讯作者：
Merkus, Peter J. F. M.
中科院分区：
文献类型：
--
作者：
van den Wijngaart, Lara S.;Roukema, Jolt;Merkus, Peter J. F. M.
电子医疗是改善医疗保健的一种有吸引力的媒介，其价值（除了标准护理之外）已在先前的研究中得到评估。我们的目的是评估电子健康干预是否可以改善哮喘控制，同时减少50%的常规门诊就诊。在一项为期16个月随访的多中心随机对照试验中，在荷兰8家医院接受治疗的哮喘儿童（616岁）被随机分为常规治疗组（4个月门诊）和使用虚拟哮喘诊所（VAC）的在线治疗组（8个月门诊，每月网络监测）。结局指标为研究最后4周无症状天数、哮喘控制、15 s用力呼气量、呼出一氧化氮分数、哮喘加重、计划外门诊就诊、住院次数、吸入皮质类固醇的每日剂量和全身皮质类固醇疗程。我们纳入了210名儿童。随访后，常规护理组和VAC组无症状天数差异有统计学意义（差异为1.23天，95% CI 0.42-2.04; p= 0.003）， VAC组优于常规护理组。在哮喘控制方面，VAC组儿童哮喘控制测试改善更大（差异为1.17点，95% CI 0.09-2.25; p= 0.03）。其他结果测量没有发现差异。通过电子健康监测哮喘儿童可以部分取代常规门诊就诊。
eHealth is an appealing medium to improve healthcare and its value (in addition to standard care) has been assessed in previous studies. We aimed to assess whether an eHealth intervention could improve asthma control while reducing 50% of routine outpatient visits.In a multicentre, randomised controlled trial with a 16-month follow-up, asthmatic children (616 years) treated in eight Dutch hospitals were randomised to usual care (4-monthly outpatient visits) and online care using a virtual asthma clinic (VAC) (8-monthly outpatient visits with monthly web-based monitoring). Outcome measures were the number of symptom-free days in the last 4 weeks of the study, asthma control, forced expiratory volume in 1 s, exhaled nitric oxide fraction, asthma exacerbations, unscheduled outpatient visits, hospital admissions, daily dose of inhaled corticosteroids and courses of systemic corticosteroids.We included 210 children. After follow-up, symptom-free days differed statistically between the usual care and VAC groups (difference of 1.23 days, 95% CI 0.42-2.04; p= 0.003) in favour of the VAC. In terms of asthma control, the Childhood Asthma Control Test improved more in the VAC group (difference of 1.17 points, 95% CI 0.09-2.25; p= 0.03). No differences were found for other outcome measures.Routine outpatient visits can partly be replaced by monitoring asthmatic children via eHealth.