Managing complex respiratory patients in the community: an evaluation of a pilot integrated respiratory care service
Managing complex respiratory patients in the community: an evaluation of a pilot integrated respiratory care service
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DOI：
10.1136/bmjresp-2016-000145
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发表时间：
2016-03-01
影响因子：
4.1
通讯作者：
Wilkinson, T. M.
中科院分区：
文献类型：
--
作者：
Gillett, K.;Lippiett, K.;Wilkinson, T. M.
简介：在英国，呼吸护理和结局存在显著差异。一个整合的方法来管理高风险的呼吸道患者，结合专家和初级保健团队的专业知识，是新的综合呼吸服务的基础，旨在减少这种变化;然而，这种模式需要评估。方法：为了评估管理高危呼吸道患者的综合服务，在两个全科医生（GP）的实践中，在当地服务中对有不良结局风险的哮喘和慢性阻塞性肺病患者进行了电子搜索，发展倡议。由初级和二级保健专业人员在联合诊所对患者进行审查。全科医生也提名患者入选。对最佳护理标准进行了审查，包括对诊断、控制、肺活量测定、自我管理、教育、药物治疗、吸入器技术和戒烟支持的评估。随访9个月后收集的常规临床资料与综合回顾前9个月的季节性匹配资料进行比较。13例（23.6%）改变了原诊断。与季节性调整的基线期相比，在9个月的随访中，吸入性皮质类固醇处方增加了23.3%，短效β 2受体激动剂处方减少了33.3%，急性呼吸道疾病加重减少了67.6%，计划外GP手术访视减少了53.3%，急性呼吸道住院从3例减少到0例。只有4名患者（7.3%）需要转诊到二级护理。卫生经济学评估显示，每例患者的相关费用减少了231.86磅。结论：在该地区的呼吸系统疾病患者的风险，次优的结果确定积极主动和管理的综合团队改善的结果，而不需要医院转诊。
Introduction: In the UK, there is significant variation in respiratory care and outcomes. An integrated approach to the management of high-risk respiratory patients, incorporating specialist and primary care teams' expertise, is the basis for new integrated respiratory services designed to reduce this variation; however, this model needs evaluating.Methods: To evaluate an integrated service managing high-risk respiratory patients, electronic searches for patients with asthma and chronic obstructive pulmonary disease at risk of poor outcomes were performed in two general practitioner (GP) practices in a local service-development initiative. Patients were reviewed at joint clinics by primary and secondary care professionals. GPs also nominated patients for inclusion. Reviews were delivered to best standards of care including assessments of diagnosis, control, spirometry, self-management, education, medication, inhaler technique and smoking cessation support. Follow-up of routine clinical data collected at 9-months postclinic were compared with seasonally matched 9-months prior to integrated review.Results: 82 patients were identified, 55 attended. 13 (23.6%) had their primary diagnosis changed. In comparison with the seasonally adjusted baseline period, in the 9-month follow-up there was an increase in inhaled corticosteroid prescriptions of 23.3%, a reduction in short-acting beta(2)-agonist prescription of 33.3%, a reduction in acute respiratory exacerbations of 67.6%, in unscheduled GP surgery visits of 53.3% and acute respiratory hospital admissions reduced from 3 to 0. Only 4 patients (7.3%) required referral to secondary care. Health economic evaluation showed respiratory-related costs per patient reduced by 231.86 pound.Conclusions: Patients with respiratory disease in this region at risk of suboptimal outcomes identified proactively and managed by an integrated team improved outcomes without the need for hospital referral.