Shelledy David C, Legrand Terry S, Gardner Donna D, Peters Jay I
College of Health Sciences, Rush University, Chicago, IL 60612-3832, USA.
J Asthma. 2009 Mar;46(2):194-201. doi: 10.1080/02770900802610068.
Asthma management programs (AMP) may reduce costs and improve outcomes in patients with moderate to severe asthma. However, it is not known which personnel are best able to deliver such interventions and what settings are most effective. The purpose of this study was to compare the effects of an in-home AMP provided by respiratory therapists (RTs) to an AMP provided by nurses (RNs) and to usual care (UC) provided in physician offices or clinics.
Subjects (age 18-64) who had been admitted to the emergency department (ED) or hospital for acute asthma exacerbation were randomized to three groups: AMP-RT, AMP-RN or UC. The AMP groups received five (5) weekly home visits to provide assessment and instruction; the UC group was instructed to return to their physician for routine follow-up. Outcomes assessed at 6 months included hospitalizations, in patient days, hospitalization cost, ED visits and cost, clinic visits, pulmonary function, symptoms, health related quality of life (HRQOL), asthma episode self-management score (AESM), environmental assessment, and patient satisfaction (PS). Variables were compared using ANOVA with a Neuman-Keuls follow-up for multiple comparisons using an intent-to-treat approach.
Upon enrollment, (n = 159) there were no differences (p > .05) between groups for age, gender, pulmonary function or HRQOL (SF-36 and St. Georges Respiratory Questionnaire - SGRQ). At 6 months, both AMP groups (AMP-RN n = 54; AMP-RT n = 46) had significantly fewer (p < 0.05) hospitalizations and in-patient days, lower hospitalization costs, and greater HRQOL physical component summary change scores (PCS) and PS than UC (n = 59). AMP-RT also had greater PEFR, SGRQ Total and SGRQ Symptoms change scores when compared to UC and significantly better AESM and PS scores as compared to AMP-RN and UC.
An in-home asthma management program can be effectively delivered by respiratory therapists and may reduce hospitalizations, in-patient days, cost and improve measures of HRQOL and PS in a population prone to asthma exacerbation.
哮喘管理项目（AMP）可能会降低中度至重度哮喘患者的成本并改善治疗效果。然而，尚不清楚哪种人员最有能力提供此类干预措施，以及哪种环境最为有效。本研究的目的是比较呼吸治疗师（RTs）提供的家庭式AMP与护士（RNs）提供的AMP以及医生办公室或诊所提供的常规护理（UC）的效果。
因急性哮喘加重而入住急诊科（ED）或医院的18 - 64岁受试者被随机分为三组：AMP - RT组、AMP - RN组或UC组。AMP组每周接受五次家访，以进行评估和指导；UC组则被指示返回其医生处进行常规随访。在6个月时评估的结果包括住院次数、住院天数、住院费用、急诊就诊次数及费用、门诊就诊次数、肺功能、症状、健康相关生活质量（HRQOL）、哮喘发作自我管理评分（AESM）、环境评估和患者满意度（PS）。使用方差分析（ANOVA）并采用纽曼 - 库尔斯后续检验进行多重比较，采用意向性分析方法对变量进行比较。
入组时（n = 159），各组在年龄、性别、肺功能或HRQOL（SF - 36和圣乔治呼吸问卷 - SGRQ）方面无差异（p > 0.05）。在6个月时，两个AMP组（AMP - RN组n = 54；AMP - RT组n = 46）的住院次数和住院天数显著少于UC组（n = 59）（p < 0.05），住院费用更低，HRQOL身体成分总结变化得分（PCS）和PS更高。与UC组相比，AMP - RT组的呼气峰流速（PEFR）、SGRQ总分和SGRQ症状变化得分也更高，与AMP - RN组和UC组相比，AESM和PS得分显著更好。
呼吸治疗师可以有效地提供家庭式哮喘管理项目，并可能减少住院次数、住院天数、成本，改善易发生哮喘加重人群的HRQOL和PS指标。
