Roberts N J, Younis I, Kidd L, Partridge M R
Research Fellow in Complex Interventions, Glasgow Caledonian University, Institute for Applied Health Research/School of Health and Life Sciences, UK.
Former MPH Student, Imperial College London, NHLI Division at Charing Cross Hospital, UK.
London J Prim Care (Abingdon). 2012;5(1):35-47. doi: 10.1080/17571472.2013.11493370.
Background Self-management improves outcomes in asthma and COPD and is strongly recommended in national and international guidelines; however implementation of the guidelines such as use of written action plans in practice is often poor. Setting A questionnaire survey was undertaken to identify the healthcare professional barriers to implementation of self-management for asthma and COPD in West London. Question Why is self-management education not being undertaken in respiratory conditions? Methods A questionnaire was designed to elicit healthcare professionals' views about barriers to implementation of self-management in asthma and COPD. Results Response rates were 33% (58/175). Results showed strong support for guideline recommendations, however implementation was patchy. Seventy six percent of respondents discussed asthma self-management with patients; however only 47.8% of patients received a written action plan. For COPD patients, 55.1% discussed self-management, with 41% receiving a written action plan. In COPD, there was greater GP involvement and less delegation of self-management. Barriers to implementation included patient factors (compliance, literacy and patient understanding), time constraints and insufficient resources. Those who believed they had witnessed improved health outcomes with self-management (53%, 31/58) were more likely to give written action plans (78%, 24/31, 'nearly always/sometimes' gave written action plans), Nearly a third of healthcare professionals reported lacking confidence in constructing written action plans (33% 19/58; GPs 43%, nurses 43%). Conclusion Despite overwhelming evidence self-management support is still not being implemented into routine clinical practice, identified barriers included time constraints, lack of training, lack of belief in patients ability to self-manage and lack of confidence completing self-management plans. Practice implications These issues need to be addressed if self-management support is to be delivered in a meaningful and effective way.
背景 自我管理可改善哮喘和慢性阻塞性肺疾病（COPD）的治疗效果，并且在国家和国际指南中都被强烈推荐；然而，这些指南的实施情况，比如在实际中使用书面行动计划，往往很差。背景 自我管理可改善哮喘和慢性阻塞性肺疾病（COPD）的治疗效果，并且在国家和国际指南中都被强烈推荐；然而，这些指南的实施情况，比如在实际中使用书面行动计划，往往很差。地点 在伦敦西部进行了一项问卷调查，以确定医疗保健专业人员在实施哮喘和COPD自我管理方面的障碍。问题 为什么在呼吸系统疾病中不开展自我管理教育？方法 设计了一份问卷，以了解医疗保健专业人员对哮喘和COPD自我管理实施障碍的看法。结果 回复率为33%（58/175）。结果显示对指南建议的大力支持，然而实施情况参差不齐。76%的受访者与患者讨论了哮喘自我管理；然而，只有47.8%的患者收到了书面行动计划。对于COPD患者，55.1%讨论了自我管理，41%收到了书面行动计划。在COPD方面，全科医生的参与度更高，自我管理的委托更少。实施障碍包括患者因素（依从性、识字能力和患者理解）、时间限制和资源不足。那些认为自己目睹了自我管理改善健康结果的人（53%，31/58）更有可能提供书面行动计划（78%，24/31，“几乎总是/有时”提供书面行动计划），近三分之一的医疗保健专业人员报告在制定书面行动计划方面缺乏信心（33%，19/58；全科医生43%，护士43%）。结论 尽管有压倒性的证据，但自我管理支持仍未纳入常规临床实践，已确定的障碍包括时间限制、缺乏培训、对患者自我管理能力缺乏信心以及完成自我管理计划缺乏信心。实践意义 如果要以有意义和有效的方式提供自我管理支持，就需要解决这些问题。
