Emtner Margareta, Hedin Anna, Andersson Mikael, Janson Christer
Department of Neuroscience, Physiotherapy, Uppsala University, SE-751 85 Uppsala, Sweden.
BMC Pulm Med. 2009 Sep 7;9:43. doi: 10.1186/1471-2466-9-43.
Asthma and COPD are major health problems and an extensive burden for the patient and the health care system. Patient education has been recommended, but the influence on knowledge and health outcomes is not fully examined. Our aims were to compare patient characteristics, education and knowledge in patients who had an emergency room (ER) visit, to explore factors related to disease knowledge, and to investigate patient characteristics, patient education and knowledge in relation to further ER visits over a 12 month period.
Eighty-four patients with asthma and 52 with COPD, who had had an ER visit, were included. They were interviewed by telephone 4 to 6 weeks after the ER visit and followed for a year.
Patients with COPD were older, more sedentary, had had more ER visits the previous year, and had more co morbidity than patients with asthma. About 80% of the patients had received information from health professionals or participated in education/rehabilitation, but a minority (< 20%) reported that their knowledge about how to handle the disease was good. Patients with "good knowledge" were younger, were more likely to have asthma diagnose, and had a higher educational background (p < 0.05). Sixty-seven percent of the patients with COPD had repeated ER visits during the following year versus 42% in asthma (p < 0.05) (adjusted HRR: 1.73 (1.03-2.90)). Patients who had had ER visits the year before inclusion had a higher risk of ER visits the following year (adjusted HRR: 3.83 (1.99-7.38)). There were no significant differences regarding patient education and knowledge between the group with and without further ER visits after adjusting for sex, diagnose, age, and educational background.
Patients with asthma had a better self reported knowledge of disease management and were less likely to have new exacerbations than patients with COPD. Reported level of knowledge was, however, in it self not a predictor of exacerbations. This indicates that information is not sufficient to reduce the burden of disease. Patient education focused on self-management and behavioral change should be emphasized.
哮喘和慢性阻塞性肺疾病（COPD）是主要的健康问题，给患者和医疗保健系统带来了沉重负担。虽然推荐了患者教育，但对知识和健康结果的影响尚未得到充分研究。我们的目的是比较因急诊室（ER）就诊的患者的特征、教育情况和知识水平，探索与疾病知识相关的因素，并调查患者特征、患者教育情况以及在12个月期间与再次ER就诊相关的知识。
纳入84例有ER就诊史的哮喘患者和52例有ER就诊史的COPD患者。在ER就诊后4至6周通过电话对他们进行访谈，并随访一年。
与哮喘患者相比，COPD患者年龄更大，运动量更少，前一年ER就诊次数更多，合并症更多。约80%的患者从医疗专业人员那里获得了信息或参加了教育/康复，但少数患者（<20%）报告称他们对如何应对疾病的知识掌握得很好。“知识掌握良好”的患者更年轻，更有可能被诊断为哮喘，且教育背景更高（p<0.05）。COPD患者中有67%在接下来的一年中再次ER就诊，而哮喘患者为42%（p<0.05）（调整后的风险比：1.73（1.03 - 2.90））。纳入前一年有ER就诊史的患者在接下来一年中ER就诊的风险更高（调整后的风险比：3.83（1.99 - 7.38））。在调整性别、诊断、年龄和教育背景后，有再次ER就诊和无再次ER就诊的患者组在患者教育和知识方面没有显著差异。
与COPD患者相比，哮喘患者自我报告的疾病管理知识更好，新发作的可能性更小。然而，报告的知识水平本身并不是发作的预测因素。这表明信息不足以减轻疾病负担。应强调以自我管理和行为改变为重点的患者教育。
