采用基于人群的方法检查哮喘护理质量。
Examining asthma quality of care using a population-based approach.
作者信息
Klomp Helena, Lawson Joshua A, Cockcroft Donald W, Chan Benjamin T, Cascagnette Paul, Gander Laurie, Jorgenson Derek
机构信息
Health Quality Council, Saskatoon, Sask.
出版信息
CMAJ. 2008 Apr 8;178(8):1013-21. doi: 10.1503/cmaj.070426.
BACKGROUND
Asthma accounts for considerable burden on health care, but in most cases, asthma can be controlled. Quality-of-care indicators would aid in monitoring asthma management. We describe the quality of asthma care using a set of proposed quality indicators.
METHODS
We performed a retrospective cross-sectional study using health databases in Saskatchewan, a Canadian province with a population of about 1 million people. We assessed 6 quality-of-care indicators among people with asthma: admission to hospital because of asthma; poor asthma control (high use of short-acting beta-agonists, admission to hospital because of asthma or death due to asthma); no inhaled corticosteroid use among patients with poor control; at least moderate inhaled corticosteroid use among patients with poor control; high inhaled corticosteroid use and use of another preventer medication among patients with poor control; and any main preventer use among patients with poor control. We calculated crude and adjusted rates with 95% confidence intervals. We tested for differences using the chi2 test for proportions and generalized linear modelling techniques.
RESULTS
In 2002/03, there were 24 616 people aged 5-54 years with asthma in Saskatchewan, representing a prevalence of 3.8%. Poor symptom control was observed in 18% of patients with asthma. Among those with poor control, 37% were not dispensed any inhaled corticosteroids, and 40% received potentially inadequate doses. Among those with poor control who were dispensed high doses of inhaled corticosteroids, 26% also used another preventer medication. Hospital admissions because of asthma were highest among those aged 6-9 years and females aged 20-44 years. Males and those in adult age groups (predominantly 20-44 years) had worse quality of care for 4 indicators examined.
INTERPRETATION
Suboptimal asthma management would be improved through increased use of inhaled corticosteroids and preventer medications, and reduced reliance on short-acting beta-agonist medications as recommended by consensus guidelines.
背景
哮喘给医疗保健带来了相当大的负担，但在大多数情况下，哮喘是可以控制的。医疗质量指标有助于监测哮喘管理情况。我们使用一组提议的质量指标来描述哮喘护理的质量。
方法
我们利用加拿大萨斯喀彻温省（人口约100万）的健康数据库进行了一项回顾性横断面研究。我们评估了哮喘患者的6项医疗质量指标：因哮喘住院；哮喘控制不佳（短效β受体激动剂使用频繁、因哮喘住院或因哮喘死亡）；控制不佳的患者未使用吸入性糖皮质激素；控制不佳的患者至少适度使用吸入性糖皮质激素；控制不佳的患者高剂量使用吸入性糖皮质激素并使用另一种预防药物；控制不佳的患者使用任何主要预防药物。我们计算了粗率和校正率以及95%置信区间。我们使用卡方检验比例和广义线性建模技术来检验差异。
结果
2002/03年，萨斯喀彻温省有24616名5至54岁的哮喘患者，患病率为3.8%。18%的哮喘患者症状控制不佳。在控制不佳的患者中，37%未被配给任何吸入性糖皮质激素，40%接受的剂量可能不足。在被配给高剂量吸入性糖皮质激素的控制不佳的患者中，26%还使用了另一种预防药物。因哮喘住院率在6至9岁儿童和20至44岁女性中最高。男性和成年年龄组（主要是20至44岁）在4项检查指标上的护理质量较差。
解读
按照共识指南的建议，增加吸入性糖皮质激素和预防药物的使用，减少对短效β受体激动剂药物的依赖，将改善哮喘管理的不理想状况。
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