Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec.
Can Respir J. 2013 Jul-Aug;20(4):265-9. doi: 10.1155/2013/496923.
Large gaps between best evidence-based care and actual clinical practice exist in respiratory medicine, and carry a significant health burden. The authors reviewed two key care gaps in each of asthma, chronic obstructive pulmonary disease and obstructive sleep apnea. Using the 'Knowledge-to-Action Framework', the nature of each gap, its magnitude, the barriers that cause and perpetuate it, and past and future strategies that might address the problem were considered. In asthma: disease control is ascertained inadequately, leading to a prevalence of poor asthma control of approximately 50%; and asthma action plans, a key component of asthma management, are provided by only 22% of physicians. In obstructive sleep apnea: disease is under-recognized, with sleep histories ascertained in only 10% of patients; and Canadian polysomnography wait times remain longer than recommended, leading to unnecessary morbidity and societal cost. In chronic obstructive pulmonary disease: a large proportion of patients seen in primary care remain undiagnosed, mainly due to underuse of spirometry; and <10% of patients are referred for pulmonary rehabilitation, despite strong evidence demonstrating its cost effectiveness. Given the prevalence of these chronic conditions and the size and nature of these gaps, the latter exact an important toll on patients, the health care system and society. In turn, complex barriers at the patient, provider and health care system levels contribute to each gap. There have been few previous attempts to bridge these gaps. Innovative and multifaceted implementation approaches are needed and have the potential to make a large impact on Canadian respiratory health.
在呼吸医学领域，最佳循证医学实践与实际临床实践之间存在着巨大的差距，这给患者带来了沉重的健康负担。本文作者回顾了哮喘、慢性阻塞性肺疾病和阻塞性睡眠呼吸暂停这三种疾病中每一种疾病存在的两个关键护理差距。作者使用“知识转化框架”，考虑了每个差距的性质、规模、导致和持续存在的障碍，以及过去和未来可能解决问题的策略。在哮喘中：疾病控制评估不足，导致大约 50%的患者哮喘控制不佳；仅有 22%的医生为患者提供哮喘行动计划，这是哮喘管理的关键组成部分。在阻塞性睡眠呼吸暂停中：疾病未得到充分认识，只有 10%的患者进行了睡眠史评估；加拿大多导睡眠图的等待时间仍然长于推荐时间，导致不必要的发病率和社会成本增加。在慢性阻塞性肺疾病中：很大一部分在初级保健中就诊的患者未被诊断出来，主要是由于肺量计的使用不足；尽管有强有力的证据表明其具有成本效益，但只有不到 10%的患者接受了肺康复治疗。鉴于这些慢性疾病的普遍性以及这些差距的规模和性质，这些差距对患者、医疗保健系统和社会造成了重要影响。反过来，患者、提供者和医疗保健系统各级的复杂障碍也促成了这些差距。之前很少有尝试来弥合这些差距。需要创新和多方面的实施方法，并有潜力对加拿大的呼吸健康产生重大影响。
