Sin Don D, Bell Neil R, Man S F Paul
James Hogg iCAPTURE Center for Cardiovascular and Pulmonary Research, Department of Medicine (Pulmonary Division), University of British Columbia, Vancouver, Canada.
Am J Med. 2004 Oct 1;117(7):479-83. doi: 10.1016/j.amjmed.2004.04.011.
Many asthmatic patients discharged from emergency departments do not have timely follow-up visits with a primary care physician. This study was conducted to determine the effectiveness of a health professional-based intervention in improving process of care and health outcomes among asthmatic patients discharged from emergency departments.
We enrolled 125 asthmatic patients, aged 5 through 50 years, from the emergency department of a community-based hospital; 62 patients were assigned to usual care and 63 to enhanced care. Enhanced care consisted of usual care plus employment of a coordinator to make follow-up appointments with the patient's primary care physician with at least one reminder telephone call to the patient.
At 6 months of follow-up, mean (+/- SD) asthma and pediatric quality-of-life scores were higher in the enhanced care group than in the usual care group (5.7 +/- 1.2 units vs. 5.0 +/- 1.3 units, P = 0.01). The enhanced care group also had a higher rate of follow-up office visits (78% [n = 44] vs. 60% [n = 33], P = 0.003), were more likely to have written action plans (46% [n = 26] vs. 25% [n = 14], P = 0.02), and had fewer asthma symptoms (1.8 +/- 1.1 units vs. 2.2 +/- 1.3 units, P = 0.09). However, these differences disappeared by 12 months of follow-up.
A simple intervention wherein a health professional facilitates follow-up visits can improve the process of care and health outcomes of high-risk asthmatic patients. However, the effect of this intervention is time limited and largely wears off by 12 months.
许多从急诊科出院的哮喘患者没有及时接受初级保健医生的随访。本研究旨在确定基于健康专业人员的干预措施在改善急诊科出院的哮喘患者护理过程和健康结局方面的有效性。
我们从一家社区医院的急诊科招募了125名年龄在5至50岁之间的哮喘患者；62名患者被分配到常规护理组，63名患者被分配到强化护理组。强化护理包括常规护理，外加聘请一名协调员为患者预约其初级保健医生的随访，并至少给患者打一次提醒电话。
在随访6个月时，强化护理组的哮喘和儿童生活质量平均（±标准差）得分高于常规护理组（5.7±1.2分对5.0±1.3分，P = 0.01）。强化护理组的随访门诊就诊率也更高（78% [n = 44] 对60% [n = 33]，P = 0.003），更有可能有书面行动计划（46% [n = 26] 对25% [n = 14]，P = 0.02），且哮喘症状更少（1.8±1.1分对2.2±1.3分，P = 0.09）。然而，到随访12个月时，这些差异消失了。
由健康专业人员协助进行随访的简单干预措施可以改善高危哮喘患者的护理过程和健康结局。然而，这种干预的效果是有时间限制的，到12个月时基本消失。
