Griffiths C, Kaur G, Gantley M, Feder G, Hillier S, Goddard J, Packe G
Department of General Practice and Primary Care, St. Bartholomew's and the Royal School of Medicine and Dentistry, Queen Mary's School of Medicine and Dentistry, London, UK.
BMJ. 2001 Oct 27;323(7319):962-6. doi: 10.1136/bmj.323.7319.962.
To explore reasons for increased risk of hospital admission among south Asian patients with asthma.
Qualitative interview study using modified critical incident technique and framework analysis.
Newham, east London, a deprived area with a large mixed south Asian population.
58 south Asian and white adults with asthma (49 admitted to hospital with asthma, 9 not admitted); 17 general practitioners; 5 accident and emergency doctors; 2 out of hours general practitioners; 1 asthma specialist nurse.
Patients' and health professionals' views on influences on admission, events leading to admission, general practices' organisation and asthma strategies, doctor-patient relationship, and cultural attitudes to asthma.
South Asian and white patients admitted to hospital coped differently with asthma. South Asians described less confidence in controlling their asthma, were unfamiliar with the concept of preventive medication, and often expressed less confidence in their general practitioner. South Asians managed asthma exacerbations with family advocacy, without systematic changes in prophylaxis, and without systemic corticosteroids. Patients describing difficulty accessing primary care during asthma exacerbations were registered with practices with weak strategies for asthma care and were often south Asian. Patients with easy access described care suggesting partnerships with their general practitioner, had better confidence to control asthma, and were registered with practices with well developed asthma strategies that included policies for avoiding hospital admission.
The different ways of coping with asthma exacerbations and accessing care may partly explain the increased risk of hospital admission in south Asian patients. Interventions that increase confidence to control asthma, confidence in the general practitioner, understanding of preventive treatment, and use of systemic corticosteroids in exacerbations may reduce hospital admissions. Development of more sophisticated asthma strategies by practices with better access and partnerships with patients may also achieve this.
探讨南亚哮喘患者住院风险增加的原因。
采用改良关键事件技术和框架分析的定性访谈研究。
伦敦东部的纽汉姆，一个贫困地区，有大量南亚混血人口。
58名患有哮喘的南亚和白人成年人（49名因哮喘住院，9名未住院）；17名全科医生；5名急诊医生；2名非工作时间的全科医生；1名哮喘专科护士。
患者和卫生专业人员对入院影响因素、导致入院的事件、全科医疗组织和哮喘策略、医患关系以及对哮喘的文化态度的看法。
住院的南亚和白人患者应对哮喘的方式不同。南亚人表示对控制哮喘的信心较低，不熟悉预防性用药的概念，并且对他们的全科医生通常信心不足。南亚人通过家庭支持来应对哮喘发作，没有系统改变预防措施，也没有使用全身性皮质类固醇。在哮喘发作期间描述难以获得初级医疗服务的患者，其注册的全科医疗机构哮喘护理策略薄弱，且通常是南亚人。容易获得医疗服务的患者描述的护理表明他们与全科医生建立了合作关系，对控制哮喘更有信心，并且注册的全科医疗机构有完善的哮喘策略，包括避免住院的政策。
应对哮喘发作和获得医疗服务的不同方式可能部分解释了南亚患者住院风险增加的原因。增强控制哮喘的信心、对全科医生的信心、对预防性治疗的理解以及在发作时使用全身性皮质类固醇的干预措施可能会减少住院人数。更容易获得医疗服务的机构制定更完善的哮喘策略并与患者建立合作关系也可能达到这一目的。
