Qamar Nashmia, Pappalardo Andrea A, Arora Vineet M, Press Valerie G
Pediatric Residency Program, University of Chicago Medical Center, Chicago, IL, USA;
Patient Relat Outcome Meas. 2011 Jul;2:81-109. doi: 10.2147/PROM.S12634. Epub 2011 Mar 6.
Patient-centered care may be pivotal in improving health outcomes for patients with asthma. In addition to increased attention in both research and clinical forums, recent legislation also highlights the importance of patient-centered outcomes research in the Patient Protection and Affordable Care Act. However, whether patient-centered care has been shown to improve outcomes for this population is unclear. To answer this question, we performed a systematic review of the literature that aimed to define current patient-focused management issues, characterize important patient-defined outcomes in asthma control, and identify current and emerging treatments related to patient outcomes and perspectives. We used a parallel search strategy via Medline(®), Cochrane Central Register of Controlled Trials, CINAHL(®) (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO(®), complemented with a reference review of key articles that resulted in a total of 133 articles; 58 were interventions that evaluated the effect on patient-centered outcomes, and 75 were descriptive studies. The majority of intervention studies demonstrated improved patient outcomes (44; "positive" results); none showed true harm (0; "negative"); and the remainder were equivocal (14; "neutral"). Key themes emerged relating to patients' desires for asthma knowledge, preferences for tailored management plans, and simplification of treatment regimens. We also found discordance between physicians and patients regarding patients' needs, beliefs, and expectations about asthma. Although some studies show promise regarding the benefits of patient-focused care, these methods require additional study on feasibility and strategies for implementation in real world settings. Further, it is imperative that future studies must be, themselves, patient-centered (eg, pragmatic comparative effectiveness studies) and applicable to a variety of patient populations and settings. Despite the need for further research, enough evidence exists that supports incorporating a patient-centered approach to asthma management, in order to achieve improved outcomes and patient health.
以患者为中心的护理对于改善哮喘患者的健康结局可能至关重要。除了在研究和临床论坛中受到更多关注外，近期的立法也在《患者保护与平价医疗法案》中强调了以患者为中心的结局研究的重要性。然而，以患者为中心的护理是否已被证明能改善该人群的结局尚不清楚。为了回答这个问题，我们对文献进行了系统综述，旨在确定当前以患者为重点的管理问题，描述哮喘控制中重要的患者定义结局，并确定与患者结局和观点相关的现有及新出现的治疗方法。我们通过Medline®、Cochrane对照试验中心注册库、CINAHL®（护理及相关健康文献累积索引）和PsycINFO®采用平行检索策略，并辅以对关键文章的参考文献综述，共获得133篇文章；其中58篇是评估对以患者为中心结局影响的干预研究，75篇是描述性研究。大多数干预研究显示患者结局得到改善（44项；“阳性”结果）；没有一项显示真正的危害（0项；“阴性”）；其余的结果不明确（14项；“中性”）。出现了一些关键主题，涉及患者对哮喘知识的需求、对量身定制管理计划的偏好以及治疗方案的简化。我们还发现医生和患者在患者对哮喘的需求、信念和期望方面存在不一致。尽管一些研究显示了以患者为中心护理的益处，但这些方法需要在现实环境中的可行性和实施策略方面进行更多研究。此外，未来的研究本身必须以患者为中心（例如，务实的比较有效性研究），并适用于各种患者群体和环境。尽管需要进一步研究，但已有足够的证据支持在哮喘管理中采用以患者为中心的方法，以实现更好的结局和患者健康。
