Legorreta A P, Leung K M, Berkbigler D, Evans R, Liu X
Health Benchmarks, Inc., Woodland Hills, California 91367, USA.
Ann Allergy Asthma Immunol. 2000 Jul;85(1):28-34. doi: 10.1016/S1081-1206(10)62430-1.
Despite the availability of the National Asthma Education Program (NAEP) guidelines since 1991, asthma remains inadequately managed. To improve quality of life, functional status, and self-management behavior of asthma patients, a large health maintenance organization (HMO) in California implemented an asthma management program in 1996.
To evaluate the effectiveness of an asthma management program in an HMO setting.
Prospective study. Survey data from members who participated in the intervention program and data from members who received usual care were analyzed using propensity score technique.
A total of 1,043 asthma patients who responded both baseline and follow-up survey were included in the analysis. From baseline to followup, participants in the in-home intervention program reported significant improvement in functional status (improvements range from 0.2 to 7.2), daily use of steroid inhaler (+4.1%), daily peak flow meter use (+6.4%), self-reported knowledge of what to do for an asthma attack (+12.4%), and feeling that their asthma was under control (+10.8%). Absenteeism (-11.8%) and hospitalization due to asthma (-3.5%) were significantly reduced from baseline to follow-up. Participants did not report significant changes in overuse of beta2-agonists and emergency room visits due to asthma. In comparison with the asthmatic patients who received usual care (non-participants), participants had significantly greater improvement on daily use of steroid inhaler (+4.0% versus -6.0%), daily use of home peak flow meter (+6.4% versus 1.9%) and self-reported knowledge on what to do for an asthma attack (+12.4% versus +5.4%).
These findings suggest that population-based programs can improve functional status, increase self-monitoring and knowledge about asthma, and decrease absenteeism and hospitalization for asthma by directly providing asthmatic patients with educational materials and self-monitoring tools. Such "direct-to-consumer" outreach programs may help bridge the gap between NAEPs 1991 practice guidelines and the reality of current asthma management.
尽管自1991年起就有国家哮喘教育计划（NAEP）指南，但哮喘的管理仍存在不足。为了改善哮喘患者的生活质量、功能状态和自我管理行为，加利福尼亚州的一家大型健康维护组织（HMO）于1996年实施了一项哮喘管理计划。
评估在HMO环境中哮喘管理计划的有效性。
前瞻性研究。使用倾向评分技术分析了参与干预计划的成员的调查数据和接受常规护理的成员的数据。
共有1043名哮喘患者参与了基线和随访调查，纳入分析。从基线到随访，家庭干预计划的参与者在功能状态方面有显著改善（改善范围为0.2至7.2），类固醇吸入器的每日使用量增加（+4.1%），每日峰值流量计的使用量增加（+6.4%），自我报告的哮喘发作应对知识增加（+12.4%），以及感觉哮喘得到控制的比例增加（+10.8%）。从基线到随访，缺勤率（-11.8%）和因哮喘住院率（-3.5%）显著降低。参与者没有报告β2激动剂过度使用和因哮喘急诊就诊方面的显著变化。与接受常规护理的哮喘患者（非参与者）相比，参与者在类固醇吸入器的每日使用量（+4.0%对-6.0%）、家庭峰值流量计的每日使用量（+6.4%对1.9%）以及自我报告的哮喘发作应对知识（+12.4%对+5.4%）方面有显著更大的改善。
这些发现表明，基于人群的计划可以通过直接为哮喘患者提供教育材料和自我监测工具来改善功能状态，增加对哮喘的自我监测和知识，并减少哮喘导致的缺勤和住院。这种“直接面向消费者”的外展计划可能有助于弥合1991年NAEP实践指南与当前哮喘管理现实之间的差距。
