[我们能否改善基层医疗中过敏性鼻炎的治疗管理？]

[Can we improve the therapeutic management of allergic rhinitis in primary care?].

作者信息

Menárguez Puche J F, Lorenzo Zapata M D, Sánchez López M I, Alcántara Muñoz P A, López Román F J, Martínez Gonzálvez A B

机构信息

Centro de Salud Virgen de la Consolación, Molina de Segura, Murcia.

出版信息

Aten Primaria. 2001 Mar 15;27(4):227-33. doi: 10.1016/S0212-6567(01)78801-4.

DOI:10.1016/S0212-6567(01)78801-4

PMID:11262331

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7684119/

Abstract

OBJECTIVE

To evaluate improvement in therapeutic management of allergic rhinitis.

DESIGN

Study of level of quality (longitudinal, prospective, intervention).

SETTING

Primary care.

PATIENTS AND OTHERS PARTICIPANTS

First evaluation (second quarter of 1995): 73 out of 305 patients were sampled (confidence 5%, accuracy 10%). Second evaluation (second quarter of 1996). Sample of 51 patients from a total of 210.

INTERVENTIONS

Explicit criteria and standard procedure, based on consensus, for rhinitis treatment and an overall indicator of the general quality of rhinitis management were analysed. Criterion 1 (C1): correctly scaled treatment; criterion 2 (C2): initial treatment of choice with inhaled corticoids; criterion 3 (C3): correct use of oral corticoids or immunotherapy; criterion 4 (C4): coadjutant therapy according to predominant symptoms. Corrective measures: ongoing training and routine use of guide to practice.

STATISTICS

index of compliance with criteria, Chi squared and Fisher's Z tests of a tail to compare both evaluations.

MEASUREMENTS AND MAIN RESULTS

First evaluation: index of compliance with C1 = 59% (CI +/- 11), C2 = 41% (CI +/- 11), C3 = 90% (CI +/- 6) and C4 = 83% (CI +/- 8). Criteria and summary indicator obtained better results in patients attended by allergists. Second evaluation with overall improvement: C1 = 68.6% (CI +/- 13), C2 = 57% (CI +/- 13), C3 = 94% (CI +/- 6), C4 = 98% (CI +/- 3). Significant differences for C4 and C2 (p < 0.05). Overall quality and quality of criteria improved for patients attended in our environment. The summary indicator went up from 35.6% to 57% (p = 0.019), with the quality levels (C1-C4) becoming the same as those of the patients with allergy attended and with significant differences in the first evaluation disappearing.

CONCLUSIONS

Ongoing training and routine use of guides to practice enables the therapeutic management of allergic rhinitis in primary care to be improved.

摘要

目的

评估变应性鼻炎治疗管理的改善情况。

设计

质量水平研究（纵向、前瞻性、干预性）。

地点

初级保健机构。

患者及其他参与者

首次评估（1995年第二季度）：从305例患者中抽取73例（置信度5%，准确度10%）。第二次评估（1996年第二季度）。从总共210例患者中抽取51例作为样本。

干预措施

分析基于共识的鼻炎治疗明确标准和标准程序以及鼻炎管理总体质量指标。标准1（C1）：治疗方案正确分级；标准2（C2）：首选吸入性糖皮质激素进行初始治疗；标准3（C3）：正确使用口服糖皮质激素或免疫疗法；标准4（C4）：根据主要症状进行辅助治疗。纠正措施：持续培训并常规使用实践指南。

统计学方法

标准符合率指数、卡方检验以及用于比较两次评估的单尾Fisher Z检验。

测量指标及主要结果

首次评估：C1符合率指数 = 59%（置信区间±11），C2 = 41%（置信区间±11），C3 = 90%（置信区间±6），C4 = 83%（置信区间±8）。在过敏专科医生诊治的患者中，各项标准及总体指标取得了更好的结果。第二次评估有总体改善：C1 = 68.6%（置信区间±13）, C2 = 57%（置信区间±13）, C3 = 94%（置信区间±6）, C4 = 98%（置信区间±3）。C4和C2有显著差异（p < 0.05）。在我们的环境中诊治的患者，总体质量和各项标准的质量均有所改善。总体指标从35.6%升至57%（p = 0.019），质量水平（C1 - C4）与由过敏专科医生诊治的患者相同，首次评估中的显著差异消失。