Cloutier Michelle M, Wakefield Dorothy B, Hall Charles B, Bailit Howard L
Department of Pediatrics, University of Connecticut Health Center, Hartford, CT 06106, USA.
Chest. 2002 Nov;122(5):1571-9. doi: 10.1378/chest.122.5.1571.
We describe the system of asthma care in Hartford, CT, an urban, minority community.
The health field concept was used to organize factors influencing asthma prevalence and severity. Data were obtained from national, state, and municipal reports, and from surveys of children in Hartford seeking medical care in an asthma program called Easy Breathing.
Between June 1, 1998, and May 1, 2000, 21% of children receiving Medicaid in Hartford did not file a medical claim. Between 1998 and 2000, the number of providers in Hartford decreased by 37% while the number of outpatient visits increased by 8%. Using claims data, we found the following: 19.0% of Hartford children had asthma (data from the International Classification of Disease, ninth revision, and the National Drug Code); and 12% of children with asthma filled a prescription for inhaled corticosteroid therapy, 83% for a bronchodilator, and 36% for an oral corticosteroid. Children with asthma were more likely to be hospitalized (10% vs 5%, respectively) and to visit an emergency department (45% vs 29%, respectively), and, on average, they had more hospital days (0.603 vs 0.415 days per child, respectively) and more outpatient visits per year (4.7 vs 2.5 visits, respectively) compared to children without asthma. Asthma prevalence in the 6,643 children surveyed in the Easy Breathing program was 41%. Persistent asthma was diagnosed in 50% of the children with asthma. Asthma prevalence varied by ethnic origin, age, and gender, and was highest in Hispanic/Puerto Rican children, in children 5 to 10 years of age, in boys up to 10 years of age, and in girls after 15 years of age.
Improved personal behaviors and medical care will have a limited sustained impact on childhood asthma until basic environmental issues are modified. The health field concept provides a mechanism with which to address the issues surrounding asthma in urban communities.
我们描述了康涅狄格州哈特福德市（一个城市少数族裔社区）的哮喘护理体系。
运用健康领域概念来组织影响哮喘患病率和严重程度的因素。数据来自国家、州和市的报告，以及对哈特福德市参加名为“轻松呼吸”哮喘项目寻求医疗护理的儿童的调查。
在1998年6月1日至2000年5月1日期间，哈特福德市接受医疗补助的儿童中有21%未提交医疗索赔。1998年至2000年期间，哈特福德市的医疗服务提供者数量减少了37%，而门诊就诊次数增加了8%。利用索赔数据，我们发现：19.0%的哈特福德市儿童患有哮喘（数据来自《国际疾病分类》第九版和国家药品代码）；12%的哮喘儿童开具了吸入性糖皮质激素治疗的处方，83%开具了支气管扩张剂处方，36%开具了口服糖皮质激素处方。与无哮喘儿童相比，哮喘儿童更有可能住院（分别为10%和5%）和前往急诊科就诊（分别为45%和29%），并且平均而言，他们每年的住院天数更多（分别为每名儿童0.603天和0.415天），门诊就诊次数也更多（分别为4.7次和2.5次）。在“轻松呼吸”项目中接受调查的6643名儿童中，哮喘患病率为41%。50%的哮喘儿童被诊断为持续性哮喘。哮喘患病率因种族、年龄和性别而异，在西班牙裔/波多黎各儿童、5至10岁儿童、10岁以下男孩以及15岁以上女孩中最高。
在基本环境问题得到改善之前，改善个人行为和医疗护理对儿童哮喘的持续影响将有限。健康领域概念提供了一种解决城市社区哮喘相关问题的机制。
