Self-management of acute asthma among low-income urban adults.
Self-management of acute asthma among low-income urban adults.
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DOI：
10.1080/02770900903029788
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发表时间：
2009-08
期刊：
影响因子：
--
通讯作者：
Rand C
中科院分区：
文献类型：
--
作者：
George M;Campbell J;Rand C
解决哮喘差异的一种方法是制定基于证据的指南来标准化哮喘护理和教育。然而，许多供应商对这些建议的采纳情况并不理想。因此，低收入的少数民族患者可能没有得到足够的指导哮喘自我管理。此外，这些患者可能无法遵循基于指南的建议。我们进行了25次访谈，以确定城市低收入成年人接受急性哮喘自我管理方案培训和实施的程度。入组了25名成人（92%为女性; 76%为非洲裔美国人;平均年龄39岁）。只有1名受试者接受了哮喘自我管理培训，只有10名（40%）使用基于短效β-2激动剂（SABA）的自我管理方案进行急性哮喘的早期治疗。没有受试者使用峰值流量计或哮喘行动计划。大多数（52%）选择最初用补充和替代医学（CAM）治疗急性哮喘，尽管SABA可用。重要的是，21例（84%）患者更喜欢使用常规和CAM治疗的综合方法。四个主题与急性哮喘自我管理出现了定性分析。第一个主题安全性反映了受试者认为CAM比SABA更安全。严重程度涉及受试者根据其所经历的症状程度确定是否适用SABA或CAM时进行的计算。第三个主题组合的速度和强度描述了受试者对整合CAM和SABA用于急性哮喘自我管理的优势的信念。最后一个主题意义的身份发言的能力，CAM提供一个定制的自我管理策略，受试者的愿望。目前尚不清楚受试者更多地使用CAM或延迟使用基于SABA的自我管理方案是否是指导不足或个人偏好的功能。无论如何，传统自我管理方案的延迟或使用不足可能会增加不良结果的风险。为此，应评估所有患者急性哮喘自我管理策略的及时性和适当性。这对易受感染的人口特别重要，因为他们承受着不成比例的疾病负担，而他们拥有的资源最少。
One approach to address asthma disparities has been to create evidence-based guidelines to standardize asthma care and education. However, the adoption of these recommendations has been suboptimal among many providers. As a result, low-income minority patients may not be receiving adequate instruction in asthma self-management. In addition, these patients may fail to follow guideline-based recommendations. We conducted 25 interviews to identify the extent to which urban low-income adults have received training in, and implement, self-management protocols for acute asthma. Twenty-five adults (92% female; 76% African American; mean age 39) were enrolled. Only one subject had received asthma self-management training and only 10 (40%) used short-acting beta-2 agonist-based (SABA) self-management protocols for the early treatment of acute asthma. No subject used a peak flow meter or an asthma action plan. Most (52%) chose to initially treat acute asthma with complementary and alternative medicine (CAM) despite the availability of SABAs. Importantly, 21 (84%) preferred an integrated approach using both conventional and CAM treatments. Four themes associated with acute asthma self-management emerged from the qualitative analysis. The first theme safety reflected subjects’ perception that CAM was safer than SABA. Severity addressed the calculation that subjects made in determining if SABA or CAM was indicated based on the degree of symptoms they were experiencing. The third theme speed and strength of the combination described subjects’ belief in the superiority of integrating CAM and SABA for acute asthma self-management. The final themesense of identity spoke to the ability of CAM to provide a customized self-management strategy that subjects desired. It is unclear if subjects’ greater use of CAM or delays in using SABA-based self-management protocols were functions of inadequate instruction or personal preference. Regardless, delays in, or under use of, conventional self-management protocols may increase the risk for an untoward outcome. To that end, all patents’ acute asthma self-management strategies should be evaluated for their timeliness and appropriateness. This would be of particular importance for vulnerable populations who bear a disproportionate burden of the disease and who have the fewest resources.
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影响因子：
14.2
作者：
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通讯作者：
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