Impact of delay in asthma diagnosis on health care service use
Impact of delay in asthma diagnosis on health care service use
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DOI：
10.2500/aap.2010.31.3358
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发表时间：
2010-07-01
影响因子：
2.8
通讯作者：
Juhn, Young J.
中科院分区：
文献类型：
--
作者：
Lynch, Brian A.;Van Norman, Chelsey A.;Juhn, Young J.
儿童哮喘诊断的延迟是常见的，并且已知会延迟哮喘特异性治疗。很少有研究调查哮喘诊断延迟是否会影响卫生保健服务的使用。本研究旨在评估哮喘诊断延迟是否会影响卫生保健服务的使用。这是一项回顾性队列研究，从839名健康儿童中抽取方便样本。276名（33%）受试者符合哮喘标准；其中179例（65%）哮喘诊断延迟，97例（35%）及时诊断。医疗保健服务数据（例如，流感疫苗、峰值流量计的可用性、住院情况、紧急护理或急诊室就诊）和全身类固醇治疗的频率从生命的前18年的医疗记录中收集。使用泊松模型和logistic回归模型对哮喘患儿的卫生服务频率和全身性类固醇的使用进行了比较，这些患儿的哮喘诊断有和没有延迟。与及时诊断的儿童相比，哮喘诊断延迟的儿童更有可能至少访问一次紧急护理中心（40.8%对21.6%;p < 0.001）。在其他医疗服务或全身类固醇使用方面没有显著差异。哮喘诊断的延迟与紧急护理就诊的增加有关，这表明护理不理想。临床医生应该意识到，儿童哮喘诊断的延迟可能导致使用不理想的卫生保健服务。
Delays in diagnosing asthma in children are common and are known to delay asthma-specific treatment. Few studies have investigated whether a delay in asthma diagnosis impacts the use of health care services. This study was designed to assess whether a delay in diagnosis of asthma influences the use of health care services. This was a retrospective cohort study with subjects elicited from a convenience sample of 839 healthy children. The criteria for asthma was met in 276 (33%) subjects; of these subjects 179 (65%) had a delay in the diagnosis of asthma and 97 (35%) had a timely diagnosis. Data on health care services (e.g., flu shot, availability of a peak flow meter, hospitalizations, and urgent care or emergency department visits) and the frequency of systemic steroid treatments were collected from medical records during the first 18 years of life. The frequencies of health service and use of systemic steroids were compared using Poisson and logistic regression models in asthmatic children with and without a delay in asthma diagnosis. Children with a delay in asthma diagnosis were more likely to visit urgent care centers at least once (40.8% versus 21.6%; p < 0.001), compared with those with a timely diagnosis. There were no significant differences in other health care service or systemic steroid use. A delay in the diagnosis of asthma was associated with an increase in urgent care visits suggesting suboptimal care. Clinicians should be aware that a delay in the diagnosis of asthma in children may result in the use of suboptimal health care services.