McNally Andrew J, Frampton Chris, Garrett John, Pattemore Philip
Department of Paediatrics, Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand.
N Z Med J. 2004 Jun 18;117(1196):U932.
Define the way childhood asthma action plans are currently being used in New Zealand; determine New Zealand doctor's recommendations about the use of an increased dose of inhaled steroids in asthma action plans; and determine if there has been any change (during the last 7 years) in the way asthma action plans are used.
A postal survey was sent to all 297 paediatricians and paediatric registrars in New Zealand, and to a random sample of 500 general practitioners (GPs). The questions related to asthma action plan use, the inclusion of an increased dose of inhaled steroid in those plans, and details of the way doctor's adjusted inhaled steroid dose. Comparisons were made for selected questions between this survey and the same survey conducted in 1995.
Valid responses were received from 179 (60%) paediatricians and paediatric registrars, and 233 (47%) GPs. 165 (70.8%) GPs and 137 (76.5%) paediatricians/paediatric registrars indicated that they used written action plans for children with asthma in their care. 184 (61.5%) respondents who used asthma action plans included a step involving an increase in the dose of inhaled steroid, compared to 83.6% in 1995 (p<0.001). GPs in 2002 were less likely to use action plans (p<0.001) and include a step with an increased dose of inhaled steroid (p=0.003) Paediatricians and paediatric registrars in 2002 were just as likely to use action plans (p=0.549), but less likely to include a step with an increased dose of inhaled steroid (p<0.001). GPs in 2002 were significantly more likely (than paediatricians and paediatric registrars) to include a step involving an increased dose of inhaled steroid (p<0.001) There has been a change in the practice of New Zealand GPs, paediatricians, and paediatric registrars--with a decreased tendency to double the dose of inhaled steroids in childhood action plans, thus suggesting doctors are cognisant of conclusions drawn by 'evidence-based medicine'.
There has also been a decline in the proportion of asthmatic children receiving a written asthma action plan, and this is inconsistent with recommendations contained in consensus documents.
明确目前新西兰儿童哮喘行动计划的使用方式；确定新西兰医生对于在哮喘行动计划中增加吸入性类固醇剂量的建议；并确定在过去7年中哮喘行动计划的使用方式是否有任何变化。
向新西兰所有297名儿科医生和儿科住院医生以及500名全科医生（GP）的随机样本发送了邮政调查问卷。问题涉及哮喘行动计划的使用、这些计划中是否包含增加吸入性类固醇剂量，以及医生调整吸入性类固醇剂量的方式细节。将本次调查与1995年进行的相同调查中选定的问题进行了比较。
收到了179名（60%）儿科医生和儿科住院医生以及233名（47%）全科医生的有效回复。165名（70.8%）全科医生和137名（76.5%）儿科医生/儿科住院医生表示他们为所护理的哮喘儿童使用书面行动计划。在使用哮喘行动计划的184名（61.5%）受访者中，有一个步骤涉及增加吸入性类固醇剂量，而1995年这一比例为83.6%（p<0.001）。2002年的全科医生使用行动计划的可能性较小（p<0.001），且纳入增加吸入性类固醇剂量步骤的可能性较小（p=0.003）。2002年儿科医生和儿科住院医生使用行动计划的可能性相同（p=0.549），但纳入增加吸入性类固醇剂量步骤的可能性较小（p<0.001）。2002年的全科医生（与儿科医生和儿科住院医生相比）纳入增加吸入性类固醇剂量步骤的可能性显著更高（p<0.001）。新西兰全科医生、儿科医生和儿科住院医生的做法发生了变化——在儿童行动计划中加倍吸入性类固醇剂量的趋势有所下降，这表明医生认识到了“循证医学”得出的结论。
接受书面哮喘行动计划的哮喘儿童比例也有所下降，这与共识文件中的建议不一致。
