专科护士干预措施减少贫困多民族地区计划外哮喘护理：东伦敦高危哮喘随机对照试验（ELECTRA）
Specialist nurse intervention to reduce unscheduled asthma care in a deprived multiethnic area: the east London randomised controlled trial for high risk asthma (ELECTRA).
作者信息
Griffiths Chris, Foster Gill, Barnes Neil, Eldridge Sandra, Tate Helen, Begum Shamoly, Wiggins Mo, Dawson Carolyn, Livingstone Anna Eleri, Chambers Mike, Coats Tim, Harris Roger, Feder Gene S
机构信息
Centre for General Practice and Primary Care, Institute of Community Health Sciences, Barts and the London, Medical Sciences, Queen Mary's School of Medicine and Dentistry, Queen Mary, University of London E1 4NS.
出版信息
BMJ. 2004 Jan 17;328(7432):144. doi: 10.1136/bmj.37950.784444.EE. Epub 2004 Jan 12.
OBJECTIVE
To determine whether asthma specialist nurses, using a liaison model of care, reduce unscheduled care in a deprived multiethnic area.
DESIGN
Cluster randomised controlled trial.
SETTING
44 general practices in two boroughs in east London.
PARTICIPANTS
324 people aged 4-60 years admitted to or attending hospital or the general practitioner out of hours service with acute asthma; 164 (50%) were South Asian patients, 108 (34%) were white patients, and 52 (16%) were from other, largely African and Afro-Caribbean, ethnicities.
INTERVENTION
Patient review in a nurse led clinic and liaison with general practitioners and practice nurses comprising educational outreach, promotion of guidelines for high risk asthma, and ongoing clinical support. Control practices received a visit promoting standard asthma guidelines; control patients were checked for inhaler technique.
MAIN OUTCOME MEASURES
Percentage of participants receiving unscheduled care for acute asthma over one year and time to first unscheduled attendance.
RESULTS
Primary outcome data were available for 319 of 324 (98%) participants. Intervention delayed time to first attendance with acute asthma (hazard ratio 0.73, 95% confidence interval 0.54 to 1.00; median 194 days for intervention and 126 days for control) and reduced the percentage of participants attending with acute asthma (58% (101/174) v 68% (99/145); odds ratio 0.62, 0.38 to 1.01). In analyses of prespecified subgroups the difference in effect on ethnic groups was not significant, but results were consistent with greater benefit for white patients than for South Asian patients or those from other ethnic groups.
CONCLUSION
Asthma specialist nurses using a liaison model of care reduced unscheduled care for asthma in a deprived multiethnic health district. Ethnic groups may not benefit equally from specialist nurse intervention.
目的
确定采用联络式护理模式的哮喘专科护士能否减少贫困多民族地区的非计划护理。
设计
整群随机对照试验。
地点
伦敦东部两个行政区的44家普通诊所。
参与者
324名年龄在4至60岁之间因急性哮喘入院或就诊于医院或全科医生非工作时间服务的患者；164名（50%）为南亚患者，108名（34%）为白人患者，52名（16%）来自其他主要是非洲和非裔加勒比族裔。
干预措施
在护士主导的诊所对患者进行评估，并与全科医生和执业护士联络，包括开展教育推广、宣传高危哮喘指南以及提供持续临床支持。对照诊所接受一次促进标准哮喘指南的访问；对照患者接受吸入器使用技术检查。
主要观察指标
一年中因急性哮喘接受非计划护理的参与者百分比以及首次非计划就诊时间。
结果
324名参与者中有319名（98%）获得了主要结局数据。干预措施延长了首次因急性哮喘就诊的时间（风险比0.73，95%置信区间0.54至1.00；干预组中位数为194天，对照组为126天），并降低了因急性哮喘就诊的参与者百分比（58%（101/174）对68%（99/145）；优势比0.62，0.38至1.01）。在对预先设定的亚组进行分析时，对不同种族群体的影响差异不显著，但结果表明白人患者比南亚患者或其他种族群体受益更大。
结论
采用联络式护理模式的哮喘专科护士减少了贫困多民族健康区哮喘的非计划护理。不同种族群体可能无法从专科护士干预中平等受益。
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