Outcomes of a population-based asthma management program: quality of life, absenteeism, and utilization
Outcomes of a population-based asthma management program: quality of life, absenteeism, and utilization
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DOI：
10.1016/s1081-1206(10)62430-1
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发表时间：
2000-07-01
影响因子：
5.9
通讯作者：
Liu, XF
中科院分区：
文献类型：
--
作者：
Legorreta, AP;Leung, KM;Liu, XF
背景：尽管自1991年以来国家哮喘教育计划（NAEP）指南可用，但哮喘仍然没有得到充分的管理。为了改善哮喘患者的生活质量、功能状态和自我管理行为，加州的一个大型健康维护组织（HMO）于1996年实施了一项哮喘管理计划。目的：评价HMO哮喘管理计划的有效性。调查数据来自参与干预计划的成员和接受常规护理的成员，采用倾向评分技术进行分析。结果：共有1,043名哮喘患者的基线和随访调查均被纳入分析。从基线到随访，家庭干预计划的参与者报告功能状态有显著改善（改善范围从0.2到7.2），每天使用类固醇吸入器（+4.1%），每天使用峰值流量计（+6.4%），自我报告的哮喘发作知识（+12.4%），以及感觉哮喘得到控制（+10.8%）。从基线到随访，缺勤（-11.8%）和因哮喘住院（-3.5%）显著减少。参与者没有报告过度使用β 2受体激动剂和因哮喘而急诊室就诊的显着变化。与接受常规护理的哮喘患者相比，（非参与者），参与者在日常使用类固醇吸入器方面有显著更大的改善（+4.0% vs-6.0%），每日使用家用峰值流量计（+6.4% vs 1.9%）和自我报告的哮喘发作时该怎么办的知识（+12.4%对+5.4%）。这些发现表明，基于人群的项目可以改善功能状态，增加自我监测和哮喘知识，并通过直接为哮喘患者提供教育材料和自我监测工具，减少因哮喘而缺勤和住院。这种“直接面向消费者”的推广计划可能有助于弥合NAEP 1991年实践指南与当前哮喘管理现实之间的差距。
Background: Despite the availability of the National Asthma Education Program (NAEP) guidelines since 1991, asthma remains inadequately managed. To improve quality of life, functional status, and self-management behavior of asthma patients, a large health maintenance oganization (HMO) in California implemented an asthma management program in 1996.Objective: To evaluate the effectiveness of an asthma management program in an HMO setting.Design and Setting: Prospective study. Survey data from members who participated in the intervention program and data from members who received usual care were analyzed using propensity score technique.Results: A total of 1,043 asthma patients who responded both baseline and follow-up survey were included in the analysis. From baseline to followup, participants in the in-home intervention program reported significant improvement in functional status (improvements range from 0.2 to 7.2), daily use of steroid inhaler (+4.1%), daily peak flow meter use (+6.4%), self-reported knowledge of what to do for an asthma attack(+12.4%), and feeling thar their asthma was under control (+10.8%). Absenteeism (-11.8%) and hospitalization due to asthma (-3.5%) were significantly reduced from baseline to follow-up. Participants did not report significant changes in overuse of beta(2)-agonists and emergency room visits due to asthma. In comparison with the asthmatic patients who received usual care (non-participants), participants had significantly greater improvement on daily use of steroid inhaler (+4.0% versus -6.0%), daily use of home peak flow meter (+6.4% versus 1.9%) and self-reported knowledge on what to do For an asthma attack (+12.4% versus +5.4%).Conclusion: These findings suggest that population-based programs can improve functional status, increase self-monitoring and knowledge about asthma, and decrease absenteeism and hospitalization for asthma by directly providing asthmatic patients with educational materials and self-monitoring tools. Such "direct-to-consumer" outreach programs may help bridge the gap between NAEPs 1991 practice guidelines and the reality of current asthma management.