Newcomb Patricia A, McGrath Kelly Wong, Covington Jack K, Lazarus Stephen C, Janson Susan L
University of Texas at Arlington, School of Nursing, Arlington, Texas 76019, USA.
J Asthma. 2010 Mar;47(2):192-7. doi: 10.3109/02770900903486397.
To describe what adult patients with asthma report about their experiences with their own self-management behavior and working with their clinicians to control asthma.
The study sample consisted of 104 patients with persistent asthma participating in a clinical trial on asthma monitoring. All subjects were seen by primary care clinicians of a large, academic medical center. This qualitative post hoc analysis examined the views of adults with asthma about their asthma-related health care. Patients attended monthly visits as part of their study participation, during which data were derived from semistructured interviews. All patients included in this analysis participated in the study for 1 year. At the end of study participation, patients were asked to complete an evaluation of their clinician's communication behavior. All study clinicians were also asked to complete a self-evaluation of their own communication behavior.
Five major themes of barriers to successful self-management were identified, including personal constraints, social constraints, communication failures, medication issues, and health care system barriers to collaboration with their clinicians. Patients most frequently reported lack of communication surrounding issues relating to day-to-day management of asthma (31%) and home management of asthma (24%). Clinicians generally rated themselves well for consistency in showing nonverbal attentiveness (89%) and maintaining interactive conversations (93%). However, only 30% of clinicians reported consistency in helping patients make decisions about asthma management and only 33% of clinicians reported consistency in tailoring medication schedules to the patient's routines.
These findings emphasize the difficulties of establishing and maintaining a therapeutic partnership between patients and clinicians. The results underscore the need for system-wide interventions that promote the success of a therapeutic patient-clinician relationship in order to achieve long-term success in chronic disease management.
描述成年哮喘患者关于自身自我管理行为的体验，以及与临床医生合作控制哮喘的情况。
研究样本包括104名持续性哮喘患者，他们参与了一项哮喘监测临床试验。所有受试者均由一家大型学术医疗中心的初级保健临床医生诊治。这项定性事后分析考察了成年哮喘患者对其哮喘相关医疗保健的看法。作为研究参与的一部分，患者每月就诊一次，在此期间，数据来源于半结构化访谈。纳入本次分析的所有患者均参与研究1年。在研究参与结束时，要求患者完成对临床医生沟通行为的评估。所有参与研究的临床医生也被要求完成对自己沟通行为的自我评估。
确定了成功自我管理的五个主要障碍主题，包括个人限制、社会限制、沟通失败、药物问题以及与临床医生合作的医疗保健系统障碍。患者最常报告的是围绕哮喘日常管理（31%）和哮喘家庭管理（24%）相关问题缺乏沟通。临床医生总体上对自己在表现出非语言关注（89%）和保持互动对话（93%）方面的一致性评价良好。然而，只有30%的临床医生报告在帮助患者做出哮喘管理决策方面具有一致性，只有33%的临床医生报告在根据患者日常安排调整用药计划方面具有一致性。
这些发现强调了在患者和临床医生之间建立和维持治疗性伙伴关系的困难。结果强调需要进行全系统干预，以促进治疗性医患关系的成功，从而在慢性病管理中取得长期成功。
