Diette G B, Skinner E A, Markson L E, Algatt-Bergstrom P, Nguyen T T, Clark R D, Wu A W
Division of Pulmonary and Critical Care Medicine, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland 21205, USA.
J Pediatr. 2001 Jan;138(1):59-64. doi: 10.1067/mpd.2001.109600.
To evaluate the consistency of pediatric asthma care with the National Asthma Education and Prevention Program Guidelines.
Cross-sectional survey at 2 managed care organizations in the United States (winter 1997-1998). The participants were parents of children (n = 318) age 5 to 17 years with asthma. There were no interventions. The outcome measures were indicators of care in 4 domains: (1) periodic physiologic assessment, (2) proper use of medications, (3) patient education, and (4) control of factors contributing to asthma severity.
Of 533 eligible patients with asthma, 318 (60%) parents responded; 59% of children were male, 76% were white, and 60% were aged 5 to 10 years. Deficiencies in care were identified in all care domains including, for patients with moderate and severe persistent symptoms, only 55% used long-term control medication daily, 49% had written instructions for handling asthma attacks, 44% had instructions for adjustment of medication before exposures, 56% had undergone allergy testing, and 54% had undergone pulmonary function testing.
There are significant opportunities to improve the quality of care for children with asthma enrolled in managed care. A comprehensive approach to improving care may be necessary to address multiple aspects of care where opportunities exist.
评估儿科哮喘护理与《国家哮喘教育与预防计划指南》的一致性。
在美国两家管理式医疗组织进行的横断面调查（1997 - 1998年冬季）。参与者为5至17岁哮喘患儿的家长（n = 318）。未进行干预。结果指标为四个领域的护理指标：（1）定期生理评估；（2）药物的正确使用；（3）患者教育；（4）控制导致哮喘严重程度的因素。
在533名符合条件的哮喘患者中，318名（60%）家长做出回应；59%的儿童为男性，76%为白人，60%年龄在5至10岁。所有护理领域均发现护理存在不足，对于中度和重度持续性症状的患者，只有55%每天使用长期控制药物，49%有处理哮喘发作的书面指导，44%有暴露前调整药物的指导，56%进行了过敏测试，54%进行了肺功能测试。
改善参加管理式医疗的哮喘患儿护理质量有很大机会。可能需要采取综合方法来改善护理，以解决存在机会的多个护理方面的问题。
