Primary Care Respiratory Research Unit, Discipline of General Practice, School of Population Health and Clinical Practice, The University of Adelaide, Adelaide, South Australia 5005, Australia.
Int J Qual Health Care. 2011 Oct;23(5):545-53. doi: 10.1093/intqhc/mzr039. Epub 2011 Jul 6.
Clinical asthma guidelines recommend spirometry for asthma diagnosis, but there is inconsistent evidence about benefits to patients in using it for ongoing management. Our aim was to determine whether training in the use of spirometry for management of asthma provided better health outcomes and improved the quality of care in the primary care setting.
Pragmatic, cluster randomized controlled trial.
General practices in two states of Australia.
Forty practices and 397 adults with asthma.
The staff of 26 intervention practices received comprehensive spirometry training. Fourteen control practices provided usual care.
Primary outcome measures were quality of life, self-reported asthma symptoms and lung function. Secondary measures related to the process of care (e.g. performance of spirometry, preparation of a written asthma action plan) and patient and general practitioner rating of the acceptability and usefulness of spirometry.
There were no statistically significant differences between the groups at 12 months for quality of life (mean difference = -0.23; 95% CI: -0.44, -0.01), days off work (rate ratio = 1.52; 95% CI: 0.91, 2.54), exacerbations (rate ratio = 1.09; 95% CI: 0.85, 1.41), asthma on waking (rate ratio = 1.21; 95% CI: 0.79, 1.85), nocturnal asthma (rate ratio = 0.98; 95% CI: 0.63, 1.51) and post-bronchodilator FEV(1)/FVC ratio (mean difference = -0.01, 95% CI: -0.03, 0.02). There was no improvement in the quality of care provided.
Training in spirometry did not result in any measurable improvement in the use of spirometry, quality of management of asthma or patient outcomes in primary care.
临床哮喘指南建议使用肺活量计进行哮喘诊断，但对于患者使用其进行持续管理的益处存在不一致的证据。我们的目的是确定在管理哮喘时进行肺活量计使用培训是否能提供更好的健康结果，并改善初级保健环境中的护理质量。
实用、聚类随机对照试验。
澳大利亚两个州的全科医生诊所。
40 个诊所和 397 名哮喘成人患者。
26 个干预诊所的工作人员接受了全面的肺活量计使用培训。14 个对照诊所提供常规护理。
主要结果测量指标为生活质量、自我报告的哮喘症状和肺功能。次要测量指标与护理过程相关（例如，肺活量计的性能、书面哮喘行动计划的制定）以及患者和全科医生对肺活量计的可接受性和有用性的评价。
在 12 个月时，两组之间在生活质量（平均差异=-0.23；95%CI：-0.44，-0.01）、缺勤天数（比率比=1.52；95%CI：0.91，2.54）、加重次数（比率比=1.09；95%CI：0.85，1.41）、醒来时的哮喘（比率比=1.21；95%CI：0.79，1.85）、夜间哮喘（比率比=0.98；95%CI：0.63，1.51）和支气管扩张剂后 FEV(1)/FVC 比值（平均差异=-0.01，95%CI：-0.03，0.02）方面均无统计学意义的差异。提供的护理质量也没有改善。
在初级保健中，肺活量计使用培训并未导致对肺活量计的使用、哮喘管理质量或患者结果的任何可衡量的改善。
