George Maureen, Campbell Jacquelyn, Rand Cynthia
Family and Community Health Division, Center for Health Disparities Research, University of Pennsylvania School of Nursing, Philadelphia, PA 19104-4217, USA.
J Asthma. 2009 Aug;46(6):618-24. doi: 10.1080/02770900903029788.
One approach to address asthma disparities has been to create evidence-based guidelines to standardize asthma care and education. However, the adoption of these recommendations has been suboptimal among many providers. As a result, low-income minority patients may not be receiving adequate instruction in asthma self-management. In addition, these patients may fail to follow guideline-based recommendations. We conducted 25 interviews to identify the extent to which urban low-income adults have received training in, and implement, self-management protocols for acute asthma. Twenty-five adults (92% female; 76% African American; mean age 39) were enrolled. Only one subject had received asthma self-management training and only 10 (40%) used short-acting beta-(2) agonist-based (SABA) self-management protocols for the early treatment of acute asthma. No subject used a peak flow meter or an asthma action plan. Most (52%) chose to initially treat acute asthma with complementary and alternative medicine (CAM) despite the availability of SABAs. Importantly, 21 (84%) preferred an integrated approach using both conventional and CAM treatments. Four themes associated with acute asthma self-management emerged from the qualitative analysis. The first theme safety reflected subjects' perception that CAM was safer than SABA. Severity addressed the calculation that subjects made in determining if SABA or CAM was indicated based on the degree of symptoms they were experiencing. The third theme speed and strength of the combination described subjects' belief in the superiority of integrating CAM and SABA for acute asthma self-management. The final themesense of identity spoke to the ability of CAM to provide a customized self-management strategy that subjects desired. It is unclear if subjects' greater use of CAM or delays in using SABA-based self-management protocols were functions of inadequate instruction or personal preference. Regardless, delays in, or under use of, conventional self-management protocols may increase the risk for an untoward outcome. To that end, all patents' acute asthma self-management strategies should be evaluated for their timeliness and appropriateness. This would be of particular importance for vulnerable populations who bear a disproportionate burden of the disease and who have the fewest resources.
解决哮喘差异问题的一种方法是制定基于证据的指南，以规范哮喘护理和教育。然而，许多医疗服务提供者对这些建议的采纳情况并不理想。因此，低收入少数族裔患者可能没有得到足够的哮喘自我管理指导。此外，这些患者可能不遵循基于指南的建议。我们进行了25次访谈，以确定城市低收入成年人在急性哮喘自我管理方案方面接受培训和实施的程度。招募了25名成年人（92%为女性；76%为非裔美国人；平均年龄39岁）。只有一名受试者接受过哮喘自我管理培训，只有10名（40%）使用基于短效β-2激动剂（SABA）的自我管理方案进行急性哮喘的早期治疗。没有受试者使用峰流速仪或哮喘行动计划。尽管有SABA，但大多数（52%）选择最初用补充和替代医学（CAM）治疗急性哮喘。重要的是，21名（84%）更喜欢采用传统治疗和CAM治疗相结合的综合方法。定性分析得出了与急性哮喘自我管理相关的四个主题。第一个主题“安全性”反映了受试者认为CAM比SABA更安全的看法。“严重程度”涉及受试者根据自身症状程度来判断是使用SABA还是CAM的计算。第三个主题“联合治疗的速度和强度”描述了受试者认为将CAM和SABA结合用于急性哮喘自我管理更具优势的信念。最后一个主题“身份认同感”指的是CAM能够提供受试者所期望的定制化自我管理策略的能力。目前尚不清楚受试者更多地使用CAM或延迟使用基于SABA的自我管理方案是由于指导不足还是个人偏好。无论如何，传统自我管理方案的延迟使用或使用不足可能会增加不良后果的风险。为此，应评估所有患者急性哮喘自我管理策略的及时性和适当性。这对那些承受疾病负担过重且资源最少的弱势群体尤为重要。
