Adams Robert J, Weiss Scott T, Fuhlbrigge Anne
Department of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, Australia.
J Allergy Clin Immunol. 2003 Aug;112(2):445-50. doi: 10.1067/mai.2003.1625.
Studies examining the influence of provider behavior and patterns of care delivery on the use of anti-inflammatory asthma therapy have been limited to selected populations or have been unable to assess the appropriateness of therapy for individuals. We have previously reported the influence of sociodemographic variables and asthma severity on reported use of asthma medications in the United States.
We sought to examine the influence of patterns of care delivery and clinician behavioral factors on the use of anti-inflammatory medication by patients with asthma.
We performed a cross-sectional national random digit dial household telephone survey in 1998 of adult patients and parents of children with current asthma. Respondents were classified as having current asthma if they had a physician's diagnosis of asthma and were either taking medication for asthma or had asthma symptoms during the past year.
One or more persons met the study criteria for current asthma in 3273 (7.8%) households in which a screening questionnaire was completed. Of the 2509 persons (721 children <16 years of age) with current asthma interviewed, 507 (20.1%) reported current use of anti-inflammatory medication. In a multiple logistic regression model controlling for asthma symptoms, reported anti-inflammatory use was significantly associated with patients reporting their physician having an excellent ability to explain asthma management (odds ratio [OR], 1.47; 95% CI, 1.09-1.98), scheduling regular visits to a physician for asthma (OR, 1.30; 95% CI, 1.02-1.64), having a written asthma action plan (OR, 1.63; 95% CI, 1.29-2.06), and being of white, non-Hispanic ethnicity (OR, 1.53; 95% CI, 1.19-1.98), along with markers of greater asthma morbidity, missing 6 or more days from work or school in the past year (OR, 1.29; 95% CI, 1.01-1.65), and hospitalization for asthma in the past year (OR, 1.74; 95% CI, 1.19-2.53). Anti-inflammatory use was less likely to be reported with younger age (OR, 0.82; 95% CI, 0.73-0.94), lower long-term asthma symptom burden (OR, 0.82; 95% CI, 0.71-0.94), use of 4 or fewer reliever inhaler canisters in the past year (OR, 0.50; 95% CI, 0.43-0.58), and smoking (OR, 0.50; 95% CI, 0.37-0.68).
How asthma care is delivered influences the use of anti-inflammatory medication. Strategies to increase regular evaluation by a physician interested in asthma, particularly for minority patients, and to increase a physician's ability to communicate asthma management to patients might improve use of anti-inflammatory therapy among patients with asthma.
研究提供者行为和护理模式对抗炎性哮喘治疗使用的影响，此前仅限于特定人群，或无法评估个体治疗的适宜性。我们之前报告过社会人口统计学变量和哮喘严重程度对美国哮喘药物报告使用情况的影响。
我们试图研究护理模式和临床医生行为因素对哮喘患者使用抗炎药物的影响。
1998年，我们在美国进行了一项全国性横断面随机数字拨号家庭电话调查，对象为成年哮喘患者和哮喘儿童的家长。如果受访者经医生诊断患有哮喘，且在过去一年中正在服用哮喘药物或有哮喘症状，则被归类为患有当前哮喘。
在完成筛查问卷的3273户家庭（7.8%）中，有一人或多人符合当前哮喘的研究标准。在接受访谈的2509名患有当前哮喘的患者（721名16岁以下儿童）中，507名（20.1%）报告当前正在使用抗炎药物。在控制哮喘症状的多因素逻辑回归模型中，报告使用抗炎药物与以下因素显著相关：患者报告其医生具备出色的哮喘管理解释能力（比值比[OR]，1.47；95%置信区间[CI]，1.09至1.98）、安排定期看哮喘医生（OR，1.30；95% CI，1.02至1.64）、有书面哮喘行动计划（OR，1.63；95% CI，1.29至2.06）、为非西班牙裔白人（OR，1.53；95% CI，1.19至1.98），以及哮喘发病率更高的指标，如过去一年旷工或缺课6天或更多天（OR，1.29；95% CI，1.01至1.65）和过去一年因哮喘住院（OR，1.74；95% CI，1.19至2.53）。年龄较小（OR，0.82；95% CI，0.73至0.94）、长期哮喘症状负担较低（OR，0.82；95% CI，0.71至0.94）、过去一年使用4个或更少缓解吸入器罐（OR，0.50；95% CI，0.43至0.58）以及吸烟（OR，0.50；95% CI，0.37至0.68）的患者报告使用抗炎药物的可能性较小。
哮喘护理的提供方式会影响抗炎药物的使用。增加对哮喘感兴趣的医生进行定期评估的策略，特别是针对少数族裔患者，以及提高医生向患者传达哮喘管理的能力，可能会改善哮喘患者的抗炎治疗使用情况。
