Do Patients of Subspecialist Physicians Benefit from Written Asthma Action Plans?
Do Patients of Subspecialist Physicians Benefit from Written Asthma Action Plans?
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专科医师的患者可以从书面哮喘行动计划中受益吗？
DOI：
10.1164/rccm.201407-1338oc
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发表时间：
2015
影响因子：
24.7
通讯作者：
Evans,David
中科院分区：
文献类型：
--
作者：
Sheares,BeverleyJ;Mellins,RobertB;Dimango,Emily;Serebrisky,Denise;Zhang,Yuan;Bye,MichaelR;Dovey,MarkE;Nachman,Sami;Hutchinson,Vincent;Evans,David
基本原理：哮喘临床指南建议，书面哮喘行动计划是必不可少的，以改善自我管理和outcomes.Objectives：为了评估书面指示的有效性，在一个书面哮喘行动计划的形式，由亚专科医生提供的一部分，在办公室访问的日常哮喘护理。方法：共有407名儿童和成人持续性哮喘接受首次护理在肺和过敏的做法，在4个城市的医疗中心随机接受书面指示（n = 204）或没有书面指示以外的处方（n = 203）从医生。测量和主要结果：使用书面哮喘行动计划表作为提供自我管理指导的工具，对任何主要结局均无显著影响：（1）哮喘症状频率，（2）急诊就诊，或（3）从基线到12个月随访的哮喘生活质量。两组的哮喘症状频率（日间症状[P< 0.0001]，夜间症状[P<0.0001]，β-激动剂使用[P <0.0001]）均显示出相似且显著的降低。干预组（P< 0.0001）和对照组（P< 0.0006）的急诊就诊次数也显著减少。成人（P< 0.0001）和儿科护理人员（P<0.0001）的哮喘生活质量评分有显著改善。结论：我们的研究结果表明，使用书面哮喘行动计划表作为一种工具，为首次接受专科护理的持续性哮喘患者提供哮喘管理指导，除了基于专科的哮喘医疗护理和教育外，没有额外的好处。www.clinicaltrials.gov
Rationale:Asthma clinical guidelines suggest written asthma action plans are essential for improving self-management and outcomes.Objectives:To assess the efficacy of written instructions in the form of a written asthma action plan provided by subspecialist physicians as part of usual asthma care during office visits.Methods:A total of 407 children and adults with persistent asthma receiving first-time care in pulmonary and allergy practices at 4 urban medical centers were randomized to receive either written instructions (n = 204) or no written instructions other than prescriptions (n = 203) from physicians.Measurements and Main Results:Using written asthma action plan forms as a vehicle for providing self-management instructions did not have a significant effect on any of the primary outcomes: (1) asthma symptom frequency, (2) emergency visits, or (3) asthma quality of life from baseline to 12-month follow-up. Both groups showed similar and significant reductions in asthma symptom frequency (daytime symptoms [P< 0.0001], nocturnal symptoms [P< 0.0001], β-agonist use [P< 0.0001]). There was also a significant reduction in emergency visits for the intervention (P< 0.0001) and control (P< 0.0006) groups. There was significant improvement in asthma quality-of-life scores for adults (P< 0.0001) and pediatric caregivers (P< 0.0001).Conclusions:Our results suggest that using a written asthma action plan form as a vehicle for providing asthma management instructions to patients with persistent asthma who are receiving subspecialty care for the first time confers no added benefit beyond subspecialty-based medical care and education for asthma.Clinical trial registered with www.clinicaltrials.gov (NCT 00149461).