Bucknall C E, Robertson C, Moran F, Stevenson R D
Glasgow Royal Infirmary.
Qual Health Care. 1992 Mar;1(1):15-20. doi: 10.1136/qshc.1.1.15.
To assess whether the management of asthma has improved from three consecutive surveys.
Retrospective case note survey of acute asthma admissions in 1983 and 1989; case notes selected from 1985-6 survey of prospectively identified patients to include only patients with a final discharge code of asthma.
A large city teaching hospital. Patients--101 patients with acute asthma as the primary diagnosis in 1983; 85 in 1985-6; and 133 in 1989, 14 of whom were subsequently transferred elsewhere.
Conformity with a checklist of important aspects of the process of asthma management including initial assessment, treatment, supervision, and discharge and review arrangements.
All patient groups were similar in age, smoking habit, and stay in hospital and, as an objective guide to severity of asthma, had similar initial pulse rates. Major improvements occurred in management: by 1989, 119(90%) patients were treated with oral corticosteroids (69(68%), 67(79%) in 1983, 1985-6 respectively) and 109(82%) with oxygen (62(61%), 51(60%)) (both p < 0.001). 114(86%) had regular recording of peak flow measurements (53(52%), 54(64%); p < 0.001), and 103/119(86%) were discharged taking oral corticosteroids (66(65%), 63(74%); p < 0.01). Significantly fewer patients, however, had their regular inhaled corticosteroid treatment increased on discharge (38/119(32%) v 53(52%), 39(46%); p < 0.01), but more were receiving high dose inhaled treatment on admission.
The management of asthma improved significantly, and the normal practice of doctors has changed in an area of practice with longstanding problems.
通过连续三次调查评估哮喘的管理情况是否有所改善。
对1983年和1989年急性哮喘入院病例进行回顾性病历调查；病历选自1985 - 1986年对前瞻性确定患者的调查，仅纳入最终出院诊断为哮喘的患者。
一家大型城市教学医院。患者——1983年101例以急性哮喘为主要诊断的患者；1985 - 1986年85例；1989年133例，其中14例随后转至其他地方。
符合哮喘管理流程重要方面的检查表，包括初始评估、治疗、监测以及出院和复诊安排。
所有患者组在年龄、吸烟习惯和住院时间方面相似，作为哮喘严重程度的客观指标，初始脉搏率也相似。管理方面有重大改善：到1989年，119例（90%）患者接受了口服皮质类固醇治疗（1983年为69例（68%），1985 - 1986年为67例（79%）），109例（82%）患者接受了吸氧治疗（1983年为62例（61%），1985 - 1986年为51例（60%））（两者p<0.001）。114例（86%）患者进行了峰值流量测量的定期记录（1983年为53例（52%），1985 - 1986年为54例（64%）；p<0.001），103/119例（86%）出院时服用口服皮质类固醇（1983年为66例（65%），1985 - 1986年为63例（74%）；p<0.01）。然而，出院时增加常规吸入皮质类固醇治疗的患者明显减少（38/119例（32%）对1983年的53例（52%）、1985 - 1986年的39例（46%）；p<0.01），但入院时接受高剂量吸入治疗的患者更多。
哮喘管理有显著改善，在一个长期存在问题的医疗领域，医生的常规做法发生了变化。
