Carpenter Delesha M, Ayala Guadalupe X, Williams Dennis M, Yeatts Karin B, Davis Stephanie, Sleath Betsy
Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
J Asthma. 2013 Sep;50(7):791-8. doi: 10.3109/02770903.2013.808347. Epub 2013 Jul 4.
This study examined whether patient-provider communication is associated with asthma-related quality of life (QOL) and asthma outcomes among children with asthma and their caregivers.
Children ages 8-16 years with asthma and their caregivers (n = 296) were recruited at five pediatric practices in North Carolina. Children and caregivers reported demographic and clinical characteristics immediately after an audio-taped medical visit with their health care provider. During a home visit that took place 1 month after the medical visit, children and caregivers reported asthma-related QOL, and caregivers reported child asthma outcomes, including asthma symptom days and missed school days. Generalized estimating equations were used to determine whether patient-provider communication during the medical visit was associated with child and caregiver QOL and child asthma outcomes 1 month later.
On average, providers asked caregivers 4.5 questions and asked children 3 questions per visit, whereas caregivers and children asked less than 1 question per visit. Providers asked children more asthma-related questions, caregivers reported better QOL and fewer asthma symptom days 1 month later. Children and caregivers with higher asthma-management self-efficacy at the office visit reported better QOL 1 month later.
Mirroring national guideline recommendations, our results suggest that providers should ask children about their asthma during medical visits. Future longitudinal studies should conduct mediation analyses to determine whether asking children asthma-related questions during medical visits increases children's asthma management self-efficacy and ultimately improve outcomes, such as QOL, health care utilization, symptom days and missed school days.
本研究探讨了医患沟通是否与哮喘患儿及其照顾者的哮喘相关生活质量（QOL）和哮喘治疗结果相关。
在北卡罗来纳州的五家儿科诊所招募了8至16岁的哮喘患儿及其照顾者（n = 296）。患儿及其照顾者在与医疗服务提供者进行录音问诊后立即报告了人口统计学和临床特征。在问诊后1个月进行的家访中，患儿及其照顾者报告了哮喘相关的生活质量，照顾者报告了患儿的哮喘治疗结果，包括哮喘症状天数和缺课天数。使用广义估计方程来确定问诊期间的医患沟通是否与1个月后的患儿及其照顾者的生活质量以及患儿的哮喘治疗结果相关。
平均而言，每次就诊时，医疗服务提供者向照顾者提问4.5个问题，向患儿提问3个问题，而照顾者和患儿每次就诊提问少于1个问题。医疗服务提供者向患儿提出更多与哮喘相关的问题，1个月后照顾者报告生活质量更好，哮喘症状天数更少。在问诊时哮喘管理自我效能较高的患儿及其照顾者在1个月后报告生活质量更好。
与国家指南建议一致，我们的结果表明医疗服务提供者在问诊时应询问患儿有关其哮喘的情况。未来的纵向研究应进行中介分析，以确定在问诊时询问患儿与哮喘相关的问题是否会提高患儿的哮喘管理自我效能，并最终改善生活质量、医疗保健利用率、症状天数和缺课天数等结果。
