关于哮喘审核对临床结果影响的实用性“真实世界”研究。
Pragmatic 'real world' study of the effect of audit of asthma on clinical outcome.
作者信息
Neville R G, Hoskins G, McCowan C, Smith B
机构信息
Asthma Research Unit, Tayside Centre for General Practice, University of Dundee, Kirsty Semple Way, Dundee DD2 4BF, UK.
出版信息
Prim Care Respir J. 2004 Dec;13(4):198-204. doi: 10.1016/j.pcrj.2004.06.007.
AIMS
To test whether participation in clinical audit is associated with improved care of a long-term health condition.
METHODS
'Real world' study comparing 1339 patients of all ages and severity of asthma managed by 77 self-selected highly motivated general practices in Scotland with 9617 patients from 319 practices from a national sample.
RESULTS
Patients managed by 'audit' practices had more structured clinical reviews by nurses [817 (61%) versus 4301 (45%) OR 0.52, 95% CI 0.46-0.58] and less acute GP contacts [440 (33%) v 4161 (43%) OR 1.56, CI 1.38-1.56]. Consequently they experienced more checking of inhaler technique, use of peak flow meters and self- management plans. 'Audit' patients had more symptom free days [365 (42%) v 2216 (23%) OR 0.80, CI 0.70-0.91], and fewer asthma attacks [217 (16%) v 1938 (20%) OR 1.30, CI 1.12-1.53]. They made less use of hospital services including A&E [30 (2%) v 326 (3%) OR 1.53, CI 1.03-2.28] and outpatients [42 (3%) v 459 (5%) OR 1.55, CI 1.11-2.16].
CONCLUSIONS
Patients with asthma benefit from being managed by a practice involved in a programme of audit.
目的
测试参与临床审计是否与改善长期健康状况的护理相关。
方法
“真实世界”研究，将苏格兰77家自我选择的积极性高的普通诊所管理的1339名各年龄段及哮喘严重程度各异的患者，与来自全国样本中319家诊所的9617名患者进行比较。
结果
由“审计”诊所管理的患者接受护士进行的结构化临床评估更多[817（61%）对4301（45%），比值比0.52，95%可信区间0.46 - 0.58]，与全科医生的急性接触更少[440（33%）对4161（43%），比值比1.56，可信区间1.38 - 1.56]。因此，他们接受吸入器技术检查、使用峰值流量计和自我管理计划的情况更多。“审计”患者无症状天数更多[365（42%）对2216（23%），比值比0.80，可信区间0.70 - 0.91]，哮喘发作次数更少[217（16%）对1938（20%），比值比1.30，可信区间1.12 - 1.53]。他们较少使用包括急症室在内的医院服务[30（2%）对326（3%），比值比1.53，可信区间1.03 - 2.28]和门诊服务[42（3%）对459（5%），比值比1.55，可信区间1.11 - 2.16]。
结论
哮喘患者受益于由参与审计计划的诊所进行管理。
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