Raju Jayasri Dasar, Soni Ambica, Aziz Naaz, Tiemstra Jeffrey D, Hasnain Memoona
Department of Family Medicine, University of Illinois at Chicago, Chicago, IL 60612-7309, USA.
Fam Med. 2012 May;44(5):348-50.
Application of the patient-centered medical home (PCMH) practice model requires managing patients with chronic diseases, such as asthma, with patient-centered approaches that ensure appropriate ongoing assessment and treatment for all patients. The Asthma Control Score (ACS) and the Asthma Action Plan (AAP) are validated tools for assessment and management of asthma. ACS use by phone has been shown to accurately assess patients' asthma control; however, no studies to date demonstrate the utility of AAP implementation by phone to improve asthma control. This study tested the effectiveness of AAP implementation by phone to improve asthma control.
Adult patients with asthma (n=48) participating in a managed care insurance plan at a university-based family medicine residency clinic were enrolled in the study. Patients were contacted by phone, and an initial ACS was assessed. Patients with an ACS <20 (uncontrolled asthma) had their medication adjusted and a new AAP implemented by phone. Uncontrolled patients were reassessed by phone monthly and management was adjusted until control was achieved.
Of 48 patients, 42 (87.5%) were reached by phone. On initial assessment, 33 (69%) were controlled. After implementation of the new AAP by phone, seven of nine (78%) initially uncontrolled patients were controlled, for a total of 40 (83%) patients controlled by the end of the study.
Asthma management using the ACS and AAP by phone is a feasible strategy that is acceptable to patients and can improve asthma control without the need for an office visit.
以患者为中心的医疗之家（PCMH）实践模式的应用要求采用以患者为中心的方法来管理慢性病患者，如哮喘患者，确保对所有患者进行适当的持续评估和治疗。哮喘控制评分（ACS）和哮喘行动计划（AAP）是用于哮喘评估和管理的有效工具。通过电话使用ACS已被证明能准确评估患者的哮喘控制情况；然而，迄今为止尚无研究表明通过电话实施AAP对改善哮喘控制的效用。本研究测试了通过电话实施AAP以改善哮喘控制的有效性。
在一家大学附属家庭医学住院医师诊所参加管理式医疗保险计划的成年哮喘患者（n = 48）被纳入研究。通过电话联系患者，并评估初始ACS。ACS < 20（哮喘未控制）患者的药物进行调整，并通过电话实施新的AAP。对未控制的患者每月进行电话重新评估，并调整管理措施直至实现控制。
48例患者中，42例（87.5%）通过电话联系上。初始评估时，33例（69%）得到控制。通过电话实施新的AAP后，9例初始未控制患者中有7例（78%）得到控制，到研究结束时共有40例（83%）患者得到控制。
通过电话使用ACS和AAP进行哮喘管理是一种可行的策略，患者可以接受，且无需门诊就诊就能改善哮喘控制。
