Systematic practice-based asthma care in the Australian setting

哮喘是一种日益影响数百万澳大利亚人健康和生活质量的疾病。近年来，许多努力都集中在改善中度和重度哮喘患者的管理方法上。政府最近的一项举措是推广使用3+访视计划，该计划鼓励在一般实践中采用更积极、更系统的方法来评估和治疗哮喘。目前还没有证据表明，如何才能最好地组织实践，以改善护理过程和患者的健康结果的方式提供这种系统的护理。本研究旨在评估改变实践组织和结构方面的有效性，例如建立哮喘患者登记册，向患者提供召回或提醒以进行定期审查，让全科医生向患者提供教育和自我管理技能，重点关注实践工作人员可以对过程做出的贡献，并启动质量保证措施，如审计和向全科医生反馈其护理质量。我们预计这些变化将为患者带来积极的利益，但也将调查在效率和成本效益的角度来看，实现这些变化的做法，患者和政府的成本。这项研究所产生的证据将为政策制定者提供建议提供一个很好的基础，并有助于在全科实践中制定哮喘患者护理的最佳实践模式。

Asthma is an illness which increasingly is affecting the health and quality of life of millions of Australians. Much effort has been focused in recent years on ways of improving the management of those people who suffer from moderate and severe asthma. A recent government initiative has been to promote the use of the 3+ Visit Plan, which encourages a more proactive, systematic approach to assessing and treating asthma in general practice. There is currently no evidence about exactly how practices can best be organized to provide this systematic care, in a way which improves the process of care and the health outcomes for patients. This study aims to evaluate the effectiveness of changing aspects of practice organization and structure, such as setting up registers of asthma patients, providing recalls or reminders to patients to come in for regular review, having the GPs provide education and self-management skills to patients, focusing on the contributions which practice staff can make to the process, and initiating quality assurance measures such as audit and feedback to the GPs about their quality of care. We anticipate that these changes will provide positive benefits for the patients, but will also investigate what it costs the practices, patients and government to bring these changes about, within the perspective of efficiency and cost-effectiveness. The evidence generated by this study will provide an excellent base for providing advice to policy makers, as well as contributing to the development of best-practice models of care for asthma patients in general practice.