Cimbollek S, Plaza V, Quirce S, Costa R, Urrutia I, Ojeda P, García J L, Sabadell C, Blanco M, Rosado A, Roura P
Hospital Virgen del Rocío, Sevilla, Spain.
Allergol Immunopathol (Madr). 2013 Mar-Apr;41(2):114-20. doi: 10.1016/j.aller.2011.09.010. Epub 2012 Feb 15.
The aim of the present study was to evaluate the knowledge, attitude and adherence to asthma management recommendations during pregnancy of Spanish health care professionals.
A multiple choice survey with 14 questions was designed. Items assessed opinion about asthma guidelines and attitudes towards treatment, spirometry, specific immunotherapy and labour in pregnant asthmatic patients. Test completion was voluntary, individual, and anonymous.
A total of 1000 questionnaires were fulfilled: respiratory medicine specialists (19.8%); allergy specialists (17.2%); primary care physicians (46.1%); and gynaecologists/obstetricians (16.9%). Guidelines were considered useful by 96.5% although 64% admitted that they followed them seldom or never. Most physicians (55.9%) answered that they would maintain asthma therapy in clinically stable patients. Almost 30% of physicians would not perform spirometry in pregnant asthma patients. 19% declared they would interrupt specific immunotherapy which had proven safe and effective. Univariate analysis revealed low adherence to be associated with the following variables: age, primary care or gynaecology/obstetrician specialisation, number of asthmatics attended per month, and declared use of guidelines for pregnant asthmatic patients. Multivariate analysis showed that being a primary care physician and a gynaecologist/obstetrician, attending a low number of asthma patients per month, and poor use of spirometry during pregnancy are associated to low adherence to asthma guidelines.
Even though the majority of Spanish physicians surveyed seem to consider guidelines useful, their adherence to those is very low if translated to managing pregnant asthmatic patients. Educational strategies seem unavoidable and should be targetted mainly to primary care and gynaecology/obstetrician physicians.
本研究旨在评估西班牙医疗保健专业人员在孕期对哮喘管理建议的知识、态度和依从性。
设计了一份包含14个问题的多项选择题调查问卷。问题评估了对哮喘指南的看法以及对哮喘孕妇治疗、肺功能测定、特异性免疫治疗和分娩的态度。测试完成是自愿、个人且匿名的。
共完成了1000份问卷：呼吸内科专家（19.8%）；过敏症专家（17.2%）；初级保健医生（46.1%）；以及妇科医生/产科医生（16.9%）。96.5%的人认为指南有用，尽管64%的人承认他们很少或从不遵循这些指南。大多数医生（55.9%）回答说他们会在临床稳定的患者中维持哮喘治疗。近30%的医生不会对哮喘孕妇进行肺功能测定。19%的人宣称他们会中断已被证明安全有效的特异性免疫治疗。单因素分析显示低依从性与以下变量相关：年龄、初级保健或妇科/产科专业、每月诊治的哮喘患者数量以及宣称使用哮喘孕妇指南。多因素分析表明，作为初级保健医生和妇科医生/产科医生、每月诊治的哮喘患者数量少以及孕期肺功能测定使用不佳与哮喘指南的低依从性相关。
尽管接受调查的大多数西班牙医生似乎认为指南有用，但如果将其应用于管理哮喘孕妇，他们对此的依从性非常低。教育策略似乎不可避免，并应主要针对初级保健医生和妇科医生/产科医生。
