Taras Howard, Wright Sandra, Brennan Jesse, Campana Jack, Lofgren RoseMarie
Community Pediatrics, University of California, San Diego, 9500 Gilman Drive, #0927, La Jolla, CA 92093-0927, USA.
J Sch Health. 2004 Aug;74(6):213-9. doi: 10.1111/j.1746-1561.2004.tb07935.x.
This project determined asthma prevalence in a large school district, absentee rates, and potential effects of school nurse case management for student asthma over three years. Data were derived from an asthma tracking tool used by nurses in one school district for every student reported as having asthma by their parent. School nurses began collecting data in their schools in 1999-2000 when an asthma-management protocol was first developed. Nurses documented perceived asthma severity for each student, presence of medication and peak flow meters in school, and case management activities provided. This data base was cross matched with percentage of days students were absent for any illness. Prevalence of asthma, based on school nurse records of parent report, was between 5.1% to 6.2% during the three years. Between 13.5% and 15% were moderate or severe. Students with asthma were absent between one-half to one and one-quarter days more often than those without asthma. In year three, 39% of students with asthma had medication at school, and 12% had a peak flow meter. Contacting a parent was the nurse case management activity provided for the largest number of students (27% of students with asthma), followed by asthma education (16.5%), contact with physician (6%), and home visits (1%). Students who received at least one school nurse case management intervention were more likely the next year to have an asthma medication at school, to use a peak flow meter at school, and to have a change in asthma severity. School nurse case management activity had no association with student absences. Availability of medication and peak flow meters at school was low, suggesting standards of care for asthma were not followed. School nurse case management, when performed outside a project or intervention, offers a promising strategy to improve asthma management.
本项目确定了一个大学校区的哮喘患病率、缺勤率，以及学校护士对学生哮喘进行病例管理三年来的潜在效果。数据来自一个学区护士使用的哮喘跟踪工具，该工具针对家长报告患有哮喘的每个学生。1999 - 2000年，当首次制定哮喘管理方案时，学校护士开始在各自学校收集数据。护士记录了每个学生的哮喘严重程度、学校内药物和峰值流量计的配备情况，以及所提供的病例管理活动。该数据库与学生因任何疾病缺勤的天数百分比进行了交叉匹配。根据学校护士记录的家长报告，三年期间哮喘患病率在5.1%至6.2%之间。13.5%至15%为中度或重度。患有哮喘的学生比没有哮喘的学生缺勤天数多半天至一天零四分之一天。在第三年，39%患有哮喘的学生在学校有药物，12%有峰值流量计。联系家长是为最多学生提供的护士病例管理活动（27%的哮喘学生），其次是哮喘教育（16.5%）、联系医生（6%）和家访（1%）。接受至少一次学校护士病例管理干预的学生，下一年更有可能在学校备有哮喘药物、使用峰值流量计，并且哮喘严重程度有所改变。学校护士病例管理活动与学生缺勤无关。学校内药物和峰值流量计的配备率较低，表明未遵循哮喘护理标准。在项目或干预之外进行的学校护士病例管理，为改善哮喘管理提供了一个有前景的策略。
