Shum K W, Lawton S, Williams H C, Docherty G, Jones J
Department of Dermatology, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, U.K.
Br J Dermatol. 1999 Sep;141(3):430-7. doi: 10.1046/j.1365-2133.1999.03035.x.
This first comprehensive study of atopic eczema management describes an audit of service structure (phase 1), process (phase 2) and outcome (phase 3) in the U.K. This paper describes the phase 1 results. Service structure was audited by a single-page questionnaire containing 10 questions on outpatient facilities. This was sent to the lead dermatologist at 187 dermatology centres throughout the U.K., and a final response rate of 98% was achieved. Although the percentage of centres reporting the presence of recommended facilities did not reach the 100% working standard for any one specific criterion, about half of the recommended items, such as provision of height and weight measuring facilities, access to a dietician, patch testing and photochemotherapy, was reported in over 90% of centres. Areas of service structure which were infrequently reported to be in place were issuing of new appointment letters asking patients to bring their treatment details to clinic (52% of centres) and access to nurses with dermatology experience on paediatric wards (57% of centres). Some audit measures, e.g. access to counselling services, showed wide regional variation (range 33-94% of centres), and these variations could not be explained simply in terms of provision of specialists. Some of the elements of service structure, such as access to nurses with dermatology experience on paediatric wards, may be difficult to change in the short term because of funding and staffing constraints, but others, such as provision of growth charts, are easy to change at little cost. This preliminary audit serves as a framework for future audits of atopic eczema management.
这项关于特应性皮炎管理的首次全面研究描述了英国医疗服务结构（第1阶段）、流程（第2阶段）和结果（第3阶段）的审核情况。本文介绍第1阶段的结果。通过一份包含10个关于门诊设施问题的单页问卷对服务结构进行审核。该问卷被发送给英国187个皮肤科中心的首席皮肤科医生，最终回复率达到了98%。尽管报告拥有推荐设施的中心比例未达到任何一项特定标准的100%的工作标准，但超过90%的中心报告了约一半的推荐项目，如提供身高和体重测量设施、可咨询营养师、进行斑贴试验和光化学疗法等。很少有报告称已具备的服务结构领域包括发放新预约信要求患者携带治疗细节到诊所（52%的中心）以及儿科病房配备有皮肤科经验的护士（57%的中心）。一些审核指标，如获得咨询服务的情况，显示出很大的地区差异（范围为33% - 94%的中心），而且这些差异不能简单地用专科医生的配备情况来解释。服务结构的一些要素，如儿科病房配备有皮肤科经验的护士，由于资金和人员配备的限制，短期内可能难以改变，但其他一些要素，如提供生长图表，很容易以低成本进行改变。这项初步审核为未来特应性皮炎管理的审核提供了一个框架。
