Smith Lorraine, Bosnic-Anticevich Sinthia Z, Mitchell Bernadette, Saini Bandana, Krass Ines, Armour Carol
The University of Sydney, Sydney, NSW, Australia.
Soc Sci Med. 2007 Apr;64(7):1501-11. doi: 10.1016/j.socscimed.2006.11.006. Epub 2007 Jan 2.
Asthma affects a considerable proportion of the population worldwide and presents a significant health problem in Australia. Given its chronic nature, effective asthma self-management approaches are important. However, despite research and interventions targeting its treatment, the management of asthma remains problematic. This study aimed to develop, from a theoretical basis, an asthma self-management model and implement it in an Australian community pharmacy setting in metropolitan Sydney, using a controlled, parallel-groups repeated-measures design. Trained pharmacists delivered a structured, step-wise, patient-focused asthma self-management program to adult participants over a 9-month period focusing on identification of asthma problems, goal setting and strategy development. Data on process- clinical- and psychosocial-outcome measures were gathered. Results showed that participants set an average of four new goals and six repeated goals over the course of the intervention. Most common goal-related themes included asthma triggers, asthma control and medications. An average of nine strategies per participant was developed to achieve the set goals. Common strategies involved visiting a medical practitioner for review of medications, improving adherence to medications and using medications before exercise. Clinical and psychosocial outcomes indicated significant improvements over time in asthma symptom control, asthma-related self-efficacy and quality of life, and negative affect. These results suggest that an asthma self-management model of illness behaviour has the potential to provide patients with a range of process skills for self-management, and deliver improvements in clinical and psychosocial indicators of asthma control. The results also indicate the capacity for the effective delivery of such an intervention by pharmacists in Australian community pharmacy settings.
哮喘影响着全球相当一部分人口，在澳大利亚也是一个重大的健康问题。鉴于其慢性本质，有效的哮喘自我管理方法很重要。然而，尽管针对其治疗进行了研究和干预，但哮喘的管理仍然存在问题。本研究旨在从理论基础出发，开发一种哮喘自我管理模型，并在悉尼大都市的澳大利亚社区药房环境中实施，采用对照、平行组重复测量设计。经过培训的药剂师在9个月的时间里为成年参与者提供了一个结构化、逐步、以患者为中心的哮喘自我管理项目，重点是识别哮喘问题、设定目标和制定策略。收集了关于过程、临床和心理社会结果指标的数据。结果显示，在干预过程中，参与者平均设定了4个新目标和6个重复目标。最常见的与目标相关的主题包括哮喘触发因素、哮喘控制和药物治疗。每位参与者平均制定了9种策略来实现设定的目标。常见策略包括拜访医生以审查药物、提高药物依从性以及在运动前使用药物。临床和心理社会结果表明，随着时间的推移，哮喘症状控制、哮喘相关自我效能感和生活质量以及负面影响都有显著改善。这些结果表明，一种疾病行为的哮喘自我管理模型有可能为患者提供一系列自我管理的过程技能，并改善哮喘控制的临床和心理社会指标。结果还表明药剂师在澳大利亚社区药房环境中有效实施这种干预的能力。
