Bolton M B, Tilley B C, Kuder J, Reeves T, Schultz L R
Henry Ford Hospital, Detroit, MI 48202-2689.
J Gen Intern Med. 1991 Sep-Oct;6(5):401-7. doi: 10.1007/BF02598160.
To determine whether a self-management training program decreases emergency department visits and reduces costs for patients with asthma.
Randomized controlled trial of an educational program.
Two sites--an urban emergency room and a suburban emergency room.
241 asthma patients between the ages of 18 and 70 years. Of the 119 patients in the intervention group and the 122 in the control group, 185 (76%) were available for follow-up.
All patients seen in the emergency departments were given usual medical care and follow-up. Patients in the intervention group were asked to attend three educational sessions on asthma conducted by a specially trained RN. The program stressed importance of medication compliance, methods to control and prevent attacks, effects of drugs and rationale for their use, relaxation exercises, and smoking cessation.
All patients received telephone interviews four, eight, and 12 months after entry into the study. Reports based on hospital admissions and emergency room utilization were verified by billing records. Three patients died during the study, none from asthma-related problems. The intervention group had significantly fewer asthma-related emergency visits (16 visits per 100 persons) than did the control group (39 per 100 persons); p = 0.0005 for the 12 months of follow-up. The effect of the intervention on asthma-related emergency department visits was strongest during the initial four months postintervention (68 per 100 persons versus 220 per 100 persons, p = 0.003). The financial analysis showed that the $85/person cost for the educational sessions was offset by the $628/person reduction in emergency room charges.
Education enables patients with asthma to decrease utilization of emergency services.
确定自我管理培训项目是否能减少哮喘患者的急诊就诊次数并降低费用。
教育项目的随机对照试验。
两个场所——一个城市急诊室和一个郊区急诊室。
241名年龄在18至70岁之间的哮喘患者。干预组的119名患者和对照组的122名患者中，185名（76%）可供随访。
在急诊室就诊的所有患者均接受常规医疗护理和随访。干预组的患者被要求参加由一名经过专门培训的注册护士举办的三次哮喘教育课程。该项目强调了药物依从性的重要性、控制和预防发作的方法、药物的作用及其使用原理、放松练习以及戒烟。
所有患者在进入研究后的4个月、8个月和12个月接受电话访谈。基于住院和急诊室利用情况的报告通过计费记录进行核实。研究期间有3名患者死亡，均非因哮喘相关问题。干预组与哮喘相关的急诊就诊次数（每100人16次就诊）显著少于对照组（每100人39次就诊）；随访12个月时p = 0.0005。干预对与哮喘相关的急诊就诊的影响在干预后的最初四个月最为显著（每100人68次就诊对每100人220次就诊，p = 0.003）。财务分析表明，教育课程每人85美元的成本被急诊室费用每人减少628美元所抵消。
教育能使哮喘患者减少急诊服务的利用。
